Health

HE A LTH • Spring 2020 17 Worcester Business Journal WBJ Worcester Business Journal Know Central Mass. Business Stay informed, engaged and connected with a print + digital subscription to the Worcester Business Journal. You'll receive bi-weekly issues, special publications and full online access. Subscribe online: wbjournal.com/subscribe, Or call: (508) 755-8004 Lown Institute, medication overload will be responsible for at least 4.6 mil- lion hospitalizations between 2020 and 2030 – and cause an estimated 150,000 premature deaths. "It's a relatively significant problem when 40% of those over 65 are taking five or more drugs," Brownlee said. "We also know it's a big problem because it's getting bigger." Harmful side effects can be different – and more severe – in older adults than younger ones. A medication that may have worked well in patients' 60s may no longer once they're in their 80s. One medication might be needed just to deal with another medication's side effects, such as an upset stomach or dry eyes, in what's called a prescribing cascade. Adverse drug events occur in 15% or more of older patients presenting to offices, hospitals, and extended care facilities, according to a 2013 study in the journal American Family Physician. Kidneys, which process most drugs through the body, decline in function as we age, Blanchard said. A bad drug interaction or side effect leaving some- one feeling groggy or disoriented could be more easily mistaken for a different ailment or simply a bad sign of aging. It could even lead to a more major physical impairment. "You could fall and break your hip," Blanchard said. Brownlee sees a few causes for the spike in prescriptions: Medical specialty associations too often see prescribing a drug as a first course of action, doctors who may not know all the medications a patient is taking, and a pharmaceu- tical industry pushing more products and mar- keting to doctors. Health compa- nies spend nearly $30 billion a year on medical mar- keting, with two- thirds geared toward persuading medi- cal professionals – not consumers – of a drug's benefit, a January 2019 Journal of the American Medical Association study found. That rate of marketing toward doctors has actually fallen since 1997, the study found, but not total spending, which nearly doubled in that time. Too often, drugs are prescribed for seniors as a preventative measure instead of in response to a condition requiring it, Brownlee said. The Pharmaceutical Research and Manufacturers of America, an industry group, also sees an issue with prescrib- ing today, particularly with what it calls a lack of communication among a patient's prescribers. "At the same time, it's disingenuous to oversimplify and find one area to blame for the negative health outcomes that seniors can expe- rience," said Nick McGee, the group's public affairs director. Learning to de-prescribe A few signs show at least a growing recognition older adults may be pre- scribed too many pills. An industry group based in Philadelphia called Choosing Wisely was formed in 2012 with a mission of avoiding care not supported by evi- dence, not truly necessary and not duplicative of other tests or procedures. The U.S. Deprescribing Research Network, funded by the National Institute on Aging, works to develop and disseminate plans for how to de- prescribe – that is, slowly taking a patient off a drug. When Blanchard was a practicing fel- low, de-prescribing wasn't even a term, he said. Now it's commonplace. There's an alternate step to turning to a prescription pad: suggesting a better diet or more regular exercise. But those suggestions may be not be received as well by a patient who might not have the desire or ability to take a more challeng- ing path, Blanchard said. A patient may also see a visit as productive only if something is prescribed, he said. "It becomes easy to add medications," Blanchard said, "but it's much harder to subtract it." Brownlee isn't encouraged. "The fact that the problem keeps getting worse and worse says that not enough clinicians are aware of it or capable of doing something about it," she said. But the Lown Institute has recom- mended a series of actions, including a potential requirement from the U.S. Food and Drug Administration about drug advertising quantifying both poten- tial benefits and harms. The institute sees a need for better coordination among providers when a patient is switching doctors. Source: Journal of the American Medical Association (2015) Most common prescriptions Seniors are most likely to take medica- tions for diabetes, antidepressants or proton-pump inhibitors. Rates have increased for eight of the 10 most com- mon prescriptions. Antidiabetic agents 19% Proton-pump inhibitors 18% Antidepressants 17% Thyroid hormones 15% Coagulation agents 15% Analgesics 14% Anxiolytics, sedatives, hypnotics 9% Anticonvulsants 9% Antiarrythmic agents 9% Bronchodilators 7% Prevalence Prescription among seniors Source: Journal of the American Medical Association (2015) Seniors with multiple prescriptions Nine out of 10 of those 65 or older take a medication, and 39% take five or more, both rates up significantly. Rate who take any prescription 84% 90% Rate who take five or more prescriptions 24% 39% 1999-2000 2011-2012 Shannon Brownlee, Lown Institute H

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