Pill Panic: Are Your Medications Causing More Harm Than Good?

Taking medications, often several each day, is almost a rite of passage into your later years. Estimates are that about 90% of older adults take at least one daily prescription medication, and about 43% take at least five different prescription medications every day. For many of us, these are life-saving and life-prolonging drugs that allow us to lead healthy and fulfilling lives, extra time that was not afforded to those in previous generations. Yet at the same time, the older we get, the more at risk we are for side effects from many prescription and non-prescription drugs. Our bodies don’t metabolize them in the same way as younger bodies do, and our kidneys don’t excrete the drugs into our urine as easily or quickly. Moreover, the more drugs we take, the more potential for drug interactions, meaning either the drugs don’t work as well as they are supposed to or may produce harmful consequences because they become entangled with other medications that can cause complications. These drug interactions and polypharmacy prescribing practices can lead to dangerous side effects and are becoming more common as the population ages.

In fact, one recent study has flagged 24 different drug pairings with the suggestion that the side effects from one drug are leading to a prescription for a second drug, something known as a “prescribing cascade,” that may lead to inappropriate and even harmful consequences for the patient. In a study published in BMJ, international experts examined the records of over 2 million older adults to identify common drug pairings that suggest risky prescribing patterns and the potential for prescribing cascades- that is, the side effects from one medication are mistakenly identified as a new medical problem leading to a prescription for a second medication, rather than addressing the cause of the side effects from the first medication. In essence, one missed side effect can lead to another (perhaps unnecessary, even harmful) second prescription. Included in these suspect drug pairings were iron supplements and laxatives, statins and pain relievers, and dementia medications leading to sleep medications. As one expert exclaimed, “One drug problem can snowball into bigger health risks.” While not every pairing of drugs is inappropriate, this research suggests that before a second medication gets added to the mix, there should first be an examination of whether an existing medication might be the cause of the new symptoms. 

This sort of “prescription cascade” could happen for several reasons. For example, if a person is already on several medications, it may be challenging to discern which one might be causing a new symptom. It can also happen that a new side effect will not surface for many weeks or even months after a drug is started, so patient and provider alike may not make the connection that one thing has to do with the other. There’s also the chance that different physicians are prescribing different medications to the same person, so each physician may not make the connection to what another is doing. And in some cases, prescribing that second medication may actually make sense, given the benefits of the medication that is causing the side effects. This is clearly a complicated issue, and given the number of medications that are taken, many for years, it’s not an easily remedied dilemma. But it underscores the need to regularly review your medications with your provider, including the possible side effects. It also highlights the need to have one comprehensive list of all medications you take, who prescribed them (including over-the-counter medications), tracking when you started the medications, what your dosages are, what the reasons for the prescription were, and what symptoms or side effects you can detect from the medication. 

There is also growing concern that several common drugs are potentially being overused by older adults at this time. According to a recent article by Paula Span in The New Old Age, clinicians may not be paying sufficient attention to potentially inappropriate medications for older adults, including benzodiazepines for insomnia or anxiety (such as Valium, Xanax, Ambien, or Ativan), which can impair balance, coordination, or cognition in older adults; aspirin, an easily obtained OTC medication that is no longer recommended for primary cardiovascular disease prevention among the general older population, but which many still take, risking gastrointestinal bleeding; and antibiotics, generally thought to be overprescribed among older adults and which lead to a substantial number of emergency room visits. There is also a recent study in the Journal of the American Geriatrics Society that, among older adults with cognitive disorders, up to ⅓ of them continue to be prescribed medications that can worsen their memory or cognition, a population least able to handle the side effects of such prescription drugs. The sort of drugs causing these issues are medications intended to treat nervous system disorders, like anxiety, sleep problems, or psychosis. This research underscores once again that in treating older adults, clinicians must take regular medication inventories to better understand the benefits or harms they are causing in their older patients.

But there is also a role for patients and their families to play when it comes to the appropriate use of prescription drugs. Given that it’s been estimated that adverse drug events are now one of the leading causes of death in the US, it behooves all older adults taking medications to become their own “medication advocate.” What does that mean? Be ready to ask your health care provider some essential questions whenever a new (or ongoing) drug has been prescribed for you, including the reason for taking the drug, the signs that the drug is working, the potential benefits and harms of the drug, and the repercussions if you stop taking it. There are so many opportunities for the “mismanagement” of taking a drug (Are you having an adverse reaction? Is the dosage you are taking correct? Is the drug interacting with something else you take?) that you must track and report back to your provider whatever you can about the medications you take. It’s important for the provider to better care for you and important for your own health and well-being, including lowering the risk for serious harm or worse should there be an unfortunate consequence from taking the medication. Stay safe out there and keep track of your meds!