It's called over-prescribing, sometimes polypharmacy, and it's a big problem for seniors. As you age, the way your body absorbs, metabolizes and excretes medications changes. This means that drug levels are not as predictable as they once were, and their effects may last for a longer time.
To make things even more difficult, many seniors take several drugs that can interact and impact the way each works in the body, setting the stage for complications.
The problem is even more serious when the drugs seniors take affect the central nervous system (CNS). Not only are these drugs likely to have more severe and more dangerous side effects than in younger patients, they can lead to falls and broken bones.
CNS drugs include medications to treat anxiety, depression, agitation, insomnia and pain. They include classes of drugs such as benzodiazepines, antidepressants, opioids, hypnotics and antipsychotics. They can cause abrupt changes in blood pressure, dizziness, confusion, unsteadiness, excessive sleepiness, changes in heart rhythm, altered thinking and memory difficulties.Many seniors take several drugs that can interact and impact the way each works in the body, setting the stage for complications.ADVERTISEMENT
Guidelines and cautions regarding prescribing central nervous system drugs in the geriatric population exist, but these are not always followed for a variety of reasons. A recent study, published in JAMA Internal Medicine, highlighted the problems.
The authors looked at medical visits by people age 65 and older between 2004 and 2013 to determine the trend in prescribing CNS medications. They were particularly interested in visits in which three or more CNS medications were prescribed, and whether the drugs were being prescribed after psychotherapy, stress management or other mental health counseling had been provided to the patients.
From 2004 to 2013, the number of polypharmacy visits more than doubled, increasing from 1.65 million to 3.68 million visits over the study period.
The largest increase in over-prescribing was seen among seniors in rural communities. Another area of over-prescribing was found in people who did not have a mental health or pain diagnosis listed to justify the prescription, indicating that no specialist had seen them. In fact, almost half of visits that resulted in multiple prescriptions of drugs acting on the nervous system lacked either a mental health or pain diagnosis.
Pain was the motivator for most of the increase in polypharmacy. The rise in opioid prescriptions in the U.S. plays a big part in this, the authors suggest.
The study is concerning, not only for the over-prescription of CNS drugs to seniors and the excessive numbers of drugs used per patient, but for a couple of other reasons.
The numbers seem to reflect the fact a growing number of senior citizens are willing to seek psychological treatment, particularly medication therapy, for mental health disorders. And when few psychiatrists are available to offer appropriate treatment in rural and other areas, non-psychiatric providers with less awareness of the potential for drug interactions and side effects are called upon to prescribe anti-anxiety and antidepressant medications. Knowing this, the authors hope, will prevent over-prescription in the future.
CNS agents should be prescribed carefully to seniors, the authors believe. But there should be an emphasis on evaluating patients' other medications, perhaps discontinuing some, if unnecessary or redundant, to avoid risky combinations.