Many people can relate to this story: my grandma was suffering from chronic pain from arthritis, anxiety and insomnia. On top of her blood thinners, cholesterol drugs and other medications, her doctor prescribed Ativan (a benzodiazepine) as a sleeping aid and anti-anxiety medication, and OxyContin (an opioid), which is at the root of our current opioid crisis. This is a woman who had never had a problem with prescription medication or addiction before. At the time, family members were unaware that these medications carried severe risks, especially for seniors. The doctor seemed to think, "who cares, she's 91, let her have her pills" and there were no other alternatives provided for my grandma. No one knew what to do. Massage, physiotherapy, alternative medicine and psychologists are expensive and time-consuming, not covered by public health insurance, and inaccessible to the elderly who often don’t drive and live off of a small pension.
My grandma became increasingly inactive and isolated. She fell several times and became increasingly frail. She insisted on continuing to be prescribed OxyContin because of her arthritis pain.
When she was hospitalized for the last time, the geriatrician took her off all her medication, knowing well that it was causing her more harm than good. But it was too late, she was already on her death bed.
This is unfortunately all too common. See Fervid's story below, which has a happier ending:
How and when did this become a problem?
Seniors are prescribed a lot of medications, many of which are helpful. Some medications help seniors that suffer from chronic diseases live meaningful and active lives. However, some medications, like sleeping pills, antipsychotics (often prescribed for dementia) and opioids do more harm than good.
How many medications are seniors on?
2 out of 3 Canadians over the age of 65 (66%) take at least 5 different prescription medications.
1 out of 4 Canadians over the age of 65 (27%) take at least 10 different prescription medications.
More than 40 per cent of seniors over the age of 85 take 10 or more medications.
(CIHI 2018 )
Studies have repeatedly shown that the more prescription drugs you’re on, the higher your chances of harmful effects of medication and hospitalizations. This is even more prevalent for seniors who are experiencing age-related changes to the body. Adverse effects of medication include side-effects, drug interactions, falls, fractures, memory problems and confusion, overdoses, hospitalizations and risk of death.
In fact, 1 in 143 Canadian seniors were hospitalized due to harmful effects of their medication, compared to 1 in 1000 non-seniors (CIHI 2018). Falls are the leading cause of injury hospitalizations for seniors in Canada (CIHI 2011). 20–30 % of hip fracture patients die within one year (Kong et al. 2012), and 30% of them are institutionalized within a year after the fracture (Morin et al. 2012).
Not only are seniors taking too many medications, but many are also being prescribed medication indicated in the American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults as being inappropriate for seniors. Others, like proton-pump inhibitors (for acid reflux) should only be used for a short amount of time.
Canadian seniors who are prescribed at least one risky medication:
65 years old and over: 31% of men and 42% of women
85 years old and over: 39% of men and 47% of women
Common risky medications for seniors include:
Benzodiazepines, sedatives and sleeping pills (e.g. diazepam/Valium, lorazepam/Ativan, alprazolam/Xanax)
Antipsychotics (e.g. Quetiapine/Seroquel, risperidone/Risperdal, Aripiprazole/Abilify)
Proton-pump inhibitors (e.g. pantoprazole/Pantoloc, esomeprazole/Nexium, omeprazole/Losec)
First-generation type-2 diabetes drugs (e.g. glyburide/Diabeta)
First generation antihistamines (e.g. promethazine, brompheniramine, diphenhydramine)
Opioids (e.g. oxycodone/ Percocet/OxyContin/Oxycet; hydrocodone/ Vicodin/Lortab/Norco; meperidine/Demerol; fentanyl/Sublimaze/Duragesic/Actiq/Fentora)
These medications increase the risk of cognitive impairment, dizziness, confusion, strokes, falls, fractures and motor vehicle accidents etc.
What to do?
It is of increasing national and international concern that older people are being prescribed more medications than ever before, many of which are inappropriate for seniors, who are suffering from far too many harmful effects.
There is a growing movement of physicians, pharmacists, nurses, patient advocates in Canada called the Canadian Deprescribing Network (CaDeN), who are raising awareness about this problem. Deprescribing is "the planned process of reducing or stopping medications that may no longer be of benefit or may be causing harm". Check out these resources for more information on medication safety and deprescribing.
One of the most important things to do is to ask doctors, nurses or pharmacists the right questions about medications, and to specifically ask for a medication review. Here's a great resource for this (click on it for the print-ready version):
Look out for your family members' health, ask the right questions and help them be proactive about their health.