Older Patients Sometimes Need to Get Off their Meds – Sometimes a Challenge

Many older adults have long lists of medications. A 2008 study found that more than 50% of older individuals take at least five medications. However, problems can arise when patients continue taking drugs for conditions that may be temporary; when they expect a prescription for treatment; and when patients see numerous doctors, who may not want to discontinue a drug another doctor prescribed. Ravi Parikh, a resident in internal medicine at Brigham & Women’s Hospital in Boston, notes that “this fragmentation creates a system where every doctor is responsible for prescribing drugs but nobody is responsible for de-prescribing.” Parikh describes a situation in which a formerly vigorous patient, aged 75 years, had fallen and become quite frail. The patient was taking at least 14 medications, including three for hypertension; however, he was also hesitant to stoptaking one of the drugs, noting how hard they had worked to lower his blood pressure. There are tools available to help providers deal with polypharmacy and the benefits of long-term medicines, such as evidence-based prognosis calculators. But Parikh writes that “changes in physicians' prescribing behavior can succeed only if patients, too, are willing to come off of medicines when they are no longer useful,” something that will require a significant shift in thinking.