Unnecessary Medications and Adverse Drug Effects

Adverse drug effects are especially problematic in the elderly because they have slowed metabolism and excretion of medications. Often times such adverse reactions are caused by the use of unnecessary medications, or the use of medications in excessive doses. Adverse drug effects are a widespread problem and can lead to significant injury and even death in the elderly. Physicians, nurses, and pharmacists are all responsible for the medication regimen in the nursing home setting.

The statistics regarding adverse drug effects are shocking. In the November 2006 issue of Clinical Geriatrics, a publication of the American Geriatric Society, the following was noted:

• 30% more money is spent in the United States on treating adverse drug effects than on all pharmaceuticals combined.
• 31% of older adults use more than one pharmacy, creating challenges for a comprehensive drug review.
• 50% of older adults receive prescriptions from more than one prescribing clinician.
• One in 12 physician visits for the elderly result in a prescription of medication that is not recommended for them.
• 6,900,000 elderly persons are currently taking medications not recommended for the elderly.
• 10.3% of all prescriptions in the United States generate an electronic safety alert to the dispensing pharmacists. Of these alerts, 88% are overridden by the dispensing pharmacist. When interviewed, some pharmacists stated they did not believe the alert was important, was not real, or that they already knew about it.

The Centers for Medicare and Medicaid Services (CMS) has taken note of the high risk of injury related to adverse drug effects. In December 2006, CMS made clarification of federal mandates to state surveyors regarding the appropriate use of medications in the nursing home setting under F329 of the OBRA regulations. The rules are not new, but facilities are receiving clarification as to what medications should be reduced or eliminated from residents’ medication regimens. The clarification makes facilities responsible for the medication regimen, more so than the physician, nurse practitioner, or physician’s assistant who ordered the medication. State surveyors evaluate compliance with such rulings, and will in essence, question the facility when rules are not followed. This clarification by CMS should be referred to when questioning whether therapy is recommended in the elderly population.

The following are questions you should ask the nursing home staff or medical provider of your loved one if you suspect medications are unnecessary or causing adverse effects:

• Is this medication necessary?
• Is the drug contraindicated in the elderly population?
• Is the resident taking the lowest effective dose of the drug?
• Are medications being used to treat side effects of other medications? For example, medications for constipation are often given to treat side effects of certain pain medications.
• Can the drug regimen be simplified?
• What are the potential drug interactions of the medications currently prescribed?

Resources

Merck

American Medical Director’s Association

Centers for Medicare and Medicaid Services