People taking several types of medications and supplements and their physicians should consider limiting pharmacotherapy. American research shows that up to 60 percent. elderly patients would take medication unnecessarily, putting their life and health at risk.
Prescribing medication is designed to help us get better and feel good. However, with so many Americans taking whole cocktails of pills, physicians are encouraged to think twice before prescribing something new, and to think about stopping medications if they are not really necessary. The idea to limit pharmacotherapy appeared in the medical literature ten years ago. In recent years, there has been growing evidence of the dangers of taking too many, including sometimes unnecessary, tablets.
But drug withdrawal will only be successful if we involve patients in the process. Because only patients are able to observe side effects of treatment that will not always be obvious to health professionals. In addition, it is the patients who should be convinced of the idea of giving up the drugs they are used to and believed to be effective.
An increasing number of Americans – especially the elderly, who suffer from multiple chronic diseases – are taking drugs and supplements that they do not need, or are taking so many of them that the substances react dangerously with each other. Research shows that at least some patients could improve their health by limiting pharmacotherapy.
While many medications have been shown to be highly effective, taking them can be harmful, especially when the patient is taking other medications. A meta-analysis of many studies on polypharmacy – taking too many drugs at the same time – shows that those affected are at risk of an adverse health event such as a fall, hospitalization, and even death. One in three hospitalizations would be associated with side effects of medication, which would lead to longer hospital stays and higher costs for medical care. The American Institute of Medicine estimated that by limiting the number of drugs to patients, up to 400 could be avoided. hospital admissions annually, saving $ 3,5 billion. Every fifth patient who is discharged home from hospital would suffer from medication side effects, which in many cases could be prevented.
It is not that any side effect in the patient would indicate that the prescribed medication would be unnecessary or harmful for him. Nevertheless, the elderly are a group of particular risk, because they suffer from chronic diseases more often than others and because of them take the whole cocktail of pills. Two-thirds of U.S. Medicare beneficiaries would suffer from two or more chronic conditions, and more than half of them would be taking at least five types of medication. On an annual basis, almost 20 percent. Medicare patients would take ten or more drugs and supplements.
One could do without some of these drugs. At least one in five patients would be treated inappropriately: taking medication unnecessarily or taking a safer drug instead of the prescribed medication. One study found that 44 percent. sick elderly people would take at least one drug unnecessarily. The study covered over 200 senior combatants suffering from diabetes suggest that more than half of them should stop taking medications to lower blood pressure or blood sugar levels. From other analyzes, even more alarming conclusions emerge: up to 60 percent. older Americans would take unnecessary medications.
While studies have shown a link between the number of medications a patient is taking and their risk of an adverse health event, the problem may be not so much with the number of medications as with the choice of medications. Some agents have already been identified as being more conducive to the occurrence of an adverse event, especially in elderly patients. For example, if you are taking psychotropic drugs such as benzodiazepines or sleeping pills, you are at an increased risk of cognitive impairment or breakdown. Diuretics and hypertension medications were also considered potentially problematic (…) and it is worth noting that even if they are problematic for some patients, they may be most appropriate for others.
However, if there are studies that show harmful effects of prescription medications, clinical trials of the effects of not taking medications have been relatively rare. Among them, there is a randomized study which showed that careful assessment of the patient’s health and a weekly review of the list of medications taken by him reduced unnecessary or inappropriate pharmacotherapy. The number of adverse health events in the experimental group decreased by 35%. The use of drugs and falls in the group of elderly patients also decreased. (…)
Other studies also suggested that withdrawing psychoactive medications helped reduce the number of falls. An extensive meta-analysis of drug withdrawal studies indicates that this may reduce the risk of death. Another recent randomized trial found that sick elderly patients could drop an average of two out of ten medications without negative side effects.
So why are patients not stopped taking medications more often? A review of research on this topic shows that at least some doctors are unaware that in some cases they are prescribing drugs incorrectly. Sometimes it is difficult for physicians to point out which drugs would be inappropriate because there are no definitive findings in this matter. In other cases, doctors believe that the positive effects of drugs outweigh their undesirable side effects.
Doctors themselves report that some patients refuse to change medications, fearing that their counterparts may not be as effective. Other studies show that doctors fear legal liability if something goes wrong, or whether they can meet the effectiveness criteria – for example, regarding the proportion of diabetic patients treated with blood sugar under control .
To reduce the problems caused by polypharmacy, experts advise physicians to routinely check their patients’ medications, especially those who are prescribed a lot of them. Such a review should also be performed when the patient is discharged from the hospital, from where the patient usually leaves with more prescriptions. The involvement of nurses and pharmacists in this task would relieve doctors and reduce the risk for patients.
The patients themselves have a significant role to play here. Walid Gellad of the University of Pittsburgh medical school recommends that each time the patient visits the doctor, is there anything I am taking that I no longer need, or something I could do without? Of course, patients should not stop taking medications on their own without consulting their doctor about this. On the other hand, the willingness to limit the number of prescribed medications should apply to both parties.