Drugging Old Folks

A recent New York Times article said nearly one in seven elderly nursing home residents - nearly all with dementia - are given powerful antipsychotics from the class known as "atypical antipsychotics" even though they increase the risk of death and are not approved for such treatments, according to a government audit. It's bad enough the drugs are dangerous and of dubious value (except for keeping residents drugged into a quiescent state) but they are also generally quite expensive and taxpayers are picking up the tab for much of the cost through government programs such as Medicare.

I have long been alarmed at the epidemic of medication overprescribing in the general public and completely disgusted at the phenomenon in the elderly nursing home population. I have seen this for years during my rotations as a pharmacy student and again as the pharmacy director of a hospital with a large nursing home attached.

There are several reasons for the excessive use of prescription drugs in this country and plenty of blame to spread up and down the chain. It starts with the patient / healthcare consumer who should inform themselves about their health issues and best practices and limitations of treatments. People are also often likely to have unrealistic expectations about the treatment of their complaints and tend to believe there is a pill to fix nearly anything wrong with them. Many would rather take a drug than make lifestyle changes that would often be much more effective than any drug available. Physicians have a central role as the healthcare provider perceived as the most knowledgeable about healthcare issues. They are also the ones best able to shape the public perception of how and when health care should be sought. Pharmacists and nurses are accessible and can provide valuable information.

Unrealistic expectations and lack of basic knowledge of reasonable and effective treatments of medical conditions leaves patients vulnerable to bad decision-making and has enormous consequences on health outcomes and costs us much more money than we can afford to spend. Especially now in a recession and high unemployment.

Unfortunately, I don't see a way out. There is too much money at stake and the people and institutions who make that money have too much power to change things easily. Most importantly, it starts with patients / consumers. If they don't make the effort to learn enough to be able make informed decisions about healthcare treatments they won't be motivated to demand better and we'll keep getting the same old highly expensive, second-rate, often unnecessary healthcare we been getting.