Overuse of Prescription Medication in the Elderly
A hospice nurse’s response to the Kaiser Health News article.
I was having my morning coffee this weekend and was trying to catch up on my reading and I read a very interesting article published by the Kaiser Health News titled, “‘America’s Other Drug Problem’: Copious Prescriptions For Hospitalized Elderly.”
I was glad to see that they were bringing this issue to the table for discussion. As healthcare professionals, we have witnessed this occurring more and more. I can attest that we in hospice also see the ramifications of the overuse of prescription medications in the elderly and specifically, the terminally ill.
I don’t want to demonize the practitioner. It is quite easy to see how it can happen, and the prescriber is usually not at all negligent or unconcerned. Just the opposite. The prescriber simply wants to minimize symptoms, treat illnesses and strive to improve a patient’s overall health.
However, the prescriber may not realize that the patient has seen three other specialists, such as a cardiologist, neurologist, dermatologist, had three trips to the emergency department, and one recent visit to the dentist, and all of those practitioners have prescribed medications for the particular ailment that the patient was visiting him or her to treat.
Yes, many functioning patients can provide the practitioner with a very detailed list of their medication profile.
Unfortunately some patients are poor historians. Others may have “forgotten” the name of their medications or still others may not be able to relay the pertinent medical information due to confusion, disorientation or the inability to communicate. This is how the polypharmacy or overuse of prescription drug issue can occur.
What Are Some of the Adverse Effects of the Over Prescribing of Medications?
This can vary. It can be nothing more than the cost factor. Medication costs have skyrocketed over the past. CBS News had an online article that stated for each person in the United States, $858 was spent on prescription drugs, compared with an average of $400 per person across 19 other industrialized nations – and that prescription medications now comprises an estimated 17 percent of overall health care expenses. This is staggering!
This doesn’t include the price of frequent physician visits or lab testing, which may be required for reassessment of the effectiveness of the drug by the physician or the requirement of performing monthly to every six-month blood testing to ensure that the drug level in the blood is within a therapeutic range.
Then we have to worry about the actual physical adverse or side effects. These effects can dramatically affect a patient’s quality of life and, at the worst, cause serious side effects up to and including death (in rare cases). Additionally, those effects can be difficult to determine which is an actual symptom or which is an adverse reaction related to the medication or to the disease that the medication was attempting to treat.
Protecting Against Overuse of Prescription Medication at End of Life
One of our jobs as hospice and palliative care professionals is to obtain a very detailed and well-investigated drug profile on all of our patients. This allows Crossroads Hospice & Palliative Care to send the medication and treatment profile to our full time pharmacist for review. This occurs not only on admission but before each IDG meeting to ensure that there are no contraindications or drug duplication issues.
The IDG team will also analyze the patient’s medication profile to determine if there are other medications that can be used in place of the patient’s current medications.
This may include using a combination drug to take the place of two other medications or finding a drug that is just as effective but more economical for the patient and/or family. It may include, with the physician’s input, a plan to discontinue non-essential medications – and even discontinuing all medications except those needed for the palliation (comfort) of the patient’s symptoms.
By performing an initial medication regimen review on admission and then with each and every medication addition, revision or discontinuation will ensure that the patient is receiving only the medications needed.
Many times a hospice patient or patient’s family will question the Crossroads staff member on why a medication is necessary or why we are discussing the discontinuation of certain medications. This is where the hospice and palliative care nurse can take the opportunity to not only educate the patient and family, but to make recommendations to solely ensure that the patient’s symptoms are controlled and quality of life is maximized to the fullest.
We as healthcare professionals promise to first “do no harm.” This includes being champions for our patients and closely monitoring their drug regimen. By being diligent and cognizant of the patient’s current condition and medication regimen, we can be proactive and work with the prescribing provider to ensure that the patient receives the best course of treatment and care, including their drug regimen.
The goal of our hospice and palliative care program is to make a difference. This means advocating for the patient in regards to their prescriptions and when appropriate, reducing polypharmacy. Expect more from us. We do.
DeAnna Looper RN, CHPN, CHPCA
Crossroads Hospice & Palliative Care
Senior Vice President of Clinical Operations
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