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No Quick Fix for the Culture of Prescribing that Drives Medication Overload

By THERESA BROWN, RN

In my mid-twenties, I was twice prescribed the common antihistamine Benadryl for allergies. However, my body’s reaction to the drug was anything but common. Instead of my hives fading, they erupted all over my body and my arms filled with extra fluid until they were almost twice normal size. I subsequently described my experience to a new allergist, who dismissed it as “coincidence.”

When I later became a nurse, I learned that seemingly “harmless” medications often cause harm, and older adults are particularly vulnerable. Every year, Americans over age 65 have preventable “adverse drug events” (ADEs) that lead to 280,000 hospital stays and nearly 5 million outpatient visits. The Lown Institute in Boston draws attention to this underrecognized problem in their recent report, Medication Overload: America’s Other Drug Problem. Policymakers, patients, and health professionals must act, because over the next decade, medication overload is predicted to cause 4.6 million hospitalizations of older Americans and 150,000 premature deaths.

Nearly half of all older adults take at least five prescription drugs, a 300 percent increase from 25 years ago. The more drugs we take, the likelier it is that one of them, or some combination, will cause serious harm. When you add in non-prescription medications, including over-the-counter drugs like ibuprofen and Tylenol, as well as vitamins and herbal supplements, the potential for harm only goes up.

I’ve seen this in my work. It is not unusual for elderly, very ill patients on hospice to have prescriptions for 20 to 30 drugs. Several of their medications may treat the same problem, amplifying any serious side effects. Blood pressure medications provide a good example. As older patients become more debilitated, lose weight, and are taxed by other health issues, the effect of these medications can intensify, severely lowering blood pressure, and causing the patients to fall. Indeed, if I am following up with a hospice patient who has fallen, the first thing I check is their prescription medications for hypertension.

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