Who puts hospitalized elderly at risk? Over-prescribing doctors.

prescriptionAmong the plenty of worries when an older patient has to be hospitalized, here’s one to think about:  treating physicians and their ever-ready prescription pads which put patients at risk for serious side effects that can be worse than the problem they’re treating.

Kaiser Health News has continued writer Anna Gorman’s series on the woes that elderly patients experience when hospitalized, with her latest piece giving an eyebrow-raising look, from a pharmacist’s point of view, at the prescribing practices of MDs in hospitals.

As the drug expert observes, it all is “a bit alarming.”

Doctors, the story underscores, write a lot of scripts for aged patients in their care. They aren’t always on top of whether these drugs might be unnecessary or unsuitable. They don’t pay sufficient attention to what other medications patients may be taking, and how drugs may interact in harmful fashion. They aren’t always as explicit as they need to be when or if the prescriptions should end. They just aren’t great about ensuring that patients understand why the drugs are needed, how they should be taken, and whether the sick and confused in their care grasp all this so they can benefit from medications when they are discharged and at home.

Polypharmacy─the practice of loading down patients with many different meds─is “America’s other drug problem. … And it is huge,” a UCLA expert is quoted as saying.

For seniors, the story notes that, “Some drugs can cause confusion, falling, excessive bleeding, low blood pressure and respiratory complications …” Federal officials have reported that the aged, who account for 35 percent of all hospital stays, experience drug-related complications about half the time, adding three days on average to their hospitalization. Adverse drug reactions affect as many as 400,000 patients annually, and add an estimated $3.5 billion to health care costs.

Hospitals can deal with the problem of polypharmacy by having pharmacists, especially those with geriatric specialization, review and exercise oversight on older patients’ presciptions─both those they’re admitted on and those issued to them while hospitalized. Pharmacists can play a beneficial role, too, in explaining meds and their proper use to patients and their caregivers.

Family members and patients may wish, too, to check their prescriptions against the Beers guidelines, a helpful list from the American Geriatrics Association. It provides information about drugs that seniors should avoid or use with caution.

Advocates continue to hope that electronic medical records may provide another safeguard on over-prescription and the administration of drugs with harmful interaction.

Ultimately, of course, physicians must bear the major responsibility for addressing the harms that bad prescribing can cause to their older patients. They aren’t easy to care for. It may seem, momentarily, that it’s merciful or best to just drug them up. I’ve written before about the care nightmares that have been caused by abusive prescribing of drugs like Risperdal, a powerful antipsychotic that too many doctors and institutions have used not to benefit patients but to get them “more compliant”─vegetative, zombie-like, and easier to handle.

Although medical experts long warned about these medications’ misuse, and regulators have prodded nursing homes and other care facilities to stop relying on them, it took criminal and civil actions, especially lawsuits in the civil justice system, to start to rollback Risperdal’s reign. Even still, doctors are prescribing the drug, off label, for hard-to-handle tots.

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