Old people love their drugs

I learned a couple of interesting statistics today in my pharmacology lecture about prescribing drugs for the elderly. For statistical purposes, the elderly include anyone over 65 years old.

• Over 10% of the elderly take at least 10 different kinds of medication.
• Over 40% of non-institutionalized elderly take at least 5 different kinds of medication. Since people that are in nursing homes or hospice care generally take more medication than that, the number of elderly who take over 5 different medications approaches 50%!

Our professor joked with us that, in general, the current elderly generation comes out of a doctor visit very satisfied if two things happen. First, the doctor must discuss a chronic but non-terminal disease that the patient has. Second, the doctor must prescribe a new medication.  For many people, these two things bring a sense of validation  and a sense that their time and money was well spent.

In all seriousness, this is a big problem. Every drug has a side effect, and multiple drugs have multiple side effects that can interact in bad ways not always obvious or foreseeable. Due to the tendency of many people to see different specialists across different fields, and to even shop around for different specialists in the same field, inadequate communication is a common occurrence. This communication lapse can easily occur between the patient and the doctor and certainly between the different doctors, and it can lead to prescribing multiple drugs that do the same thing or multiple drugs that should not be mixed.

Furthermore, there is a propensity for something called the “ADE prescribing cascade” to happen, which can make things worse. The idea is that someone is given a drug, and the adverse drug effect (ADE) is interpreted by the physician as a symptom of a new disease process. This warrants the prescription of another drug, which gives the patient a new side effect, another drug is prescribed, and so forth.

Since most elderly patients don’t know any more about the drugs they are on than which color pills they should take at which time, this only emphasizes that we should all make sure our elderly friends and family have a good primary care physician. They need someone who will take the time to sit down and think about the interactions between the different drugs that doctors across different specialties have prescribed. They need someone who will not overmedicate. They need a good medical home.

At this point, I have little interest in becoming a primary care physician, but it’s easy to imagine that they probably do more good for the overall health of a population in general than any other specialist.



I am a medical student at BCM and all thoughts are my own. I am not a doctor. Please read the disclaimer.
Head on over and like Baylor Doctor on Facebook!