AGING
October 29, 2015

Dialing Down Medication for the Elderly

Some seniors on blood pressure and diabetes medications can end up dangerously over-medicated.

Over-medication can become a big problem in older adults. It happens innocently enough — a person goes to the doctor and is diagnosed with a health problem and given a prescription for the appropriate medication and dosage they need. As the years go by, and more ongoing health issues arise, seniors can end up taking an increasing number of medications that, together, do more harm than good.

This is especially true when dealing with medications that are meant to lower blood pressure and blood sugar levels, or both. In people over 70, low levels of either can be dangerous, causing weakness, confusion, blurred vision, and fainting.

As the years go by and more ongoing health issues arise, seniors can end up on an increasing number of medications that, together, do more harm than good.

The safest course of action for some vulnerable elderly may be not prescribing a drug or reducing the dose a person takes, according to a research letter and commentary published in JAMA Internal Medicine. “Evidence is accumulating that older individuals with diabetes mellitus have little to gain from the treatment burdens of stringent blood glucose control,” the authors of the research letter write.

University of Michigan Medical School researchers analyzed information collected from both patient records and primary care provider surveys through the VA Ann Arbor Healthcare System to see the extent of the over-prescribing problem.

Of over 400,000 elderly patients who could have had their medication dosages lowered, only one in four actually did. And when the 600 health care professionals surveyed for the study were asked what they would do about a hypothetical case of a 77-year-old man with diabetes and signs of low blood sugar, only half of those surveyed said that they would consider offering less intensive treatment.

“As physicians, we want to make sure patients get the care they need, but we should also avoid care that might harm them,” researcher Eve Kerr said in a statement.

Lowering medication is not the first thing doctors think of, and some of the health care practitioners in the study were concerned that by reducing medication dosage for some patients they might be doing more harm than good. Several doctors expressed hesitation due to legal concerns.

For most elderly patients, their current medication is focused on keeping blood pressure and sugar levels in check long-term. However, as they age the likelihood of having critically low levels increases.

“Physicians are used to thinking about when to start medications, and if a patient isn't complaining and appears to be doing fine, stopping medications may not be the first thing on their mind…As we get more precise evidence about the degree of benefit and harm from using these medications, it's showing us that we need to dial back in some patients,” according to researcher Tanner Caverly, who led the survey of primary care professionals.

Reducing the amount or number of medications an elderly person takes may also come as a relief for patients — some must remember to take multiple medications and frequently check their blood pressure.

The studies were based on care taking place in the VA system, which is actively trying to de-intensify treatment in its facilities nationwide for its oldest patients. Follow-up studies are already being done to determine what, if any, negative effects these changes may have.

Patients should never change their doses of prescribed medications on their own. For every drug treatment plan, it is best to have an open dialogue with all involved — from the doctor to the patient to anyone responsible for their care.

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