Every day, 750 older Americans are hospitalized due to serious side effects from one or more medications. The odds of experiencing a serious adverse reaction to a medication increases 7 to 10 percent with each additional drug—yet today, more than 40 percent of older Americans regularly take 5 or more prescription drugs, and nearly 20 percent take more than 10 medications. When over-the-counter meds are included, a full two-thirds of older adults take 5 or more medications.
If current trends continue, the Lown Institute predicts, over the next decade there will be more than 4.5 million hospitalizations of older adults for serious side effects of medications.
To stem the tide of harm, the Lown Institute today released Eliminating Medication Overload: A National Action Plan. The plan was developed by a group of 22 experts in medication use, including patient advocates, physicians, nurses, pharmacists and researchers from the U.S. and Canada. Eleven additional experts served on an advisory board.
“A lot of attention is currently focused on the cost of medications,” says Shannon Brownlee, senior vice president of the Lown Institute and co-author of last April’s report, Medication Overload: America’s Other Drug Problem, which laid out the scope of medication-related harm. “The most costly medications are those that are not needed, or are causing harm. Over the next decade, the U.S. is on track to spend $62 billion on unnecessary hospitalizations caused by too many meds. More importantly, medication harm will lead to the premature death of more than 150,000 older Americans.”
Eliminating Medication Overload recommends five high-level action areas:
- Implement prescription checkups: Patients using multiple medications need regular prescription checkups—visits where they review all their medications with their primary care provider and identify unnecessary or potentially harmful meds that can be safely deprescribed (discontinued or reduced in dose).
- Raise awareness among clinicians, policymakers, and the public: The American health care system and the public have been lulled into thinking there is a “pill for every ill.” The scope and severity of the problem of medication overload is invisible to health care professionals and policymakers, the very stakeholders who must take action to ensure patient safety. Targeted campaigns as well as larger, mass appeal efforts to raise awareness would encourage patients to “ask their doctors” if medications are wrong for them.
- Improve information at the point of care: Health care providers do not have clear, accurate, up-to-date information on the harms and benefits of medications when making prescribing decisions, nor do they necessarily have a full list of the medications their patients are taking—and for what reason. Improving clinical guidelines and electronic health records are two essential actions.
- Educate and train health professionals to reduce medication overload: Health care professionals are reluctant to deprescribe because they have insufficient training in this area. In professional schools and continuing education, curricula must be adapted to an older population, with greater emphasis on the potential harm of medication for older adults.
- Reduce the influence of the pharmaceutical industry: The pharmaceutical industry has two strategies to increase profits: raise prices and increase consumption. Though there have been amazing breakthroughs in pharmacological treatments, direct-to-consumer advertising of drugs and drug rep visits to physician offices overemphasize the potential benefits while downplaying side effects. Regulatory action is needed to ensure advertising and marketing provide accurate information related to medication use, particularly for older patients.
“Clinicians have access to easy-to-use point-of-care guidance about how to prescribe medications. We should aim for similarly accessible and easy-to-use tools for deprescribing,” says Michael Steinman, professor of medicine at University of California, San Francisco, a member of the Medication Overload advisory board, and co-director of the U.S. Deprescribing Research Network.
“Medication helps many older people make the most of increased longevity, but that can only happen when all of our treatments are optimized to be used safely and to meet our personal needs,” says Sunny Linnebur, PharmD, president of the American Geriatrics Society (AGS), which affirmed the value of the action plan. “These recommendations from the Lown Institute join critical tools like the AGS Beers Criteria® for helping the public, policymakers, and health care professionals understand how better medication management can improve health, safety, and independence for us all.”
AGS is one of more than 15 national and international organizations have officially supported the National Action Plan. Among others, these include Community Catalyst, Institute for Healthcare Improvement, Bruyère Research Institute, John A. Hartford Foundation, Kaiser Permanente, Nurses Improving Care for Healthsystem Elders (NICHE), Canadian Deprescribing Network, and PEER (Partnerships for Enhanced Engagement in Research).
“It is incumbent upon all stakeholders to come together to address the serious harm that can result from poorly managed medications,” says Terry Fulmer, president of the John A. Hartford Foundation. “As our Age-Friendly Health Systems initiative emphasizes, medication should not interfere with what matters to an older person, with their cognitive abilities, or their mobility. Prescription checkups, as recommended in the Lown report, are an excellent tool for reviewing the efficacy of medications and deprescribing as needed.”
Eliminating Medication Overload will be available online beginning the evening of January 27. To view the report, go to www.lowninstitute.org/pills.
The leadership of the Lown Institute, members of the working groups, and project advisors are available for interviews. Please contact Karen Kahn at the number above.
Support for this research was provided by the Gordon and Betty Moore Foundation.
About the Lown Institute: Founded by world-renowned cardiologist and humanitarian Bernard Lown, the Lown Institute is a nonpartisan think tank dedicated to transforming America’s high-cost, low-value health system. The institute conducts research, generates bold ideas, and creates a vision for a just and caring system of health that works for all.