Juggling Multiple Medications

Multiple prescriptions for senior patients yield bad reactions unless well managed

(RxWiki News) Too many seniors have been taking trips to the hospital due to bad reactions among multiple prescriptions. Electronic health records may not be the best answer either.

In a recent review, two doctors set out to find evidence on how to reduce the rates of hospitalization for inappropriate medication combinations and dosages among patients 65 years of age and older.

The researchers found that the best way to reduce hospitalizations may be for doctors to lower medication doses and to use more valid calculation methods when prescribing certain common medications.

"Tell your doctors about all of your meds."

Nathan Hitzeman, MD, and Katherine Belsky, MD, from the Sutter Health Family Medicine Residency Program in Sacramento, California, teamed up to write a recommendation for doctors to follow when managing patients 65 years of age and older who are taking several prescription medications.

According to the authors, bad reactions among medications have been responsible for around 100,000 hospitalizations per year in patients aged 65 and older.

The authors said that some patients need to take multiple medications. However, the risk of bad reactions in senior patients may increase as the number of prescriptions increases.

The American Geriatrics Society has provided doctors with the Beers criteria to help them manage medications for senior patients. The Beers criterion tool is used to make sure doses of certain medications are appropriate and combinations of medications that interact poorly are avoided.

Drs. Hitzeman and Belsky looked at 10 studies that focused on managing multiple medications in patients aged 65 and older.

In the studies, nearly 22,000 patients, with an average age of 74, were taking an average of eight different prescription medications.

The researchers found that for a person taking any two medications, the risk of a bad reaction was 13 percent. For a person taking any five medications, the risk for a bad reaction was 58 percent. And for a person taking seven or more medications, the risk for a bad reaction was 82 percent.

In two of the studies that used the Beers criteria, patients in an intervention group that focused on managing multiple medications only scored 2 percent better than the non-intervention group on their Medication Appropriateness Index score. This finding means that the Beers criteria did not help much in lowering the risk of inappropriate medication dosages and the potential for bad reactions.

Hospitalization is not the only risk factor for poor management of multiple medications; lower quality of life can also be a side effect.

One of the reviewed studies looked at several thousand nursing home patients over the course of 90 days after their pharmacists had been trained on how to better manage multiple medications.

Teaching the pharmacists how to better manage patients’ multiple medications resulted in a lower relative risk for hospitalization, as no one ended up in the hospital for a bad reaction over the 90-day period.

In another study, doctors used electronic prescription monitoring software to manage their patients. While new inappropriate prescriptions were reduced by 18 percent with the software, existing inappropriate prescriptions remained the same.

The software alerted the doctors every time there was a potential threat, but only one out of every 2,700 computer alerts actually prevented a bad reaction. Doctors complained about “alert fatigue” from all of the unnecessary alerts.

A report from the Centers for Disease Control and Prevention (CDC) showed that out of 177,000 hospital visits by patients 65 years and older, only 9 percent were due to medications listed on the Beers criteria. One in three of the hospital visits were from insulin, the heart medication digoxin (Lanoxin) or the blood thinner warfarin (Coumadin).

The authors recommended that, in order to reduce bad medication interactions, healthcare professionals should:

  • Use good risk calculators for bleeding in patients taking blood thinners.
  • Set less strict goals for insulin levels in older patients with other diseases.
  • Keep doses low for digoxin unless there’s a compelling reason for a higher dose.

This study was published in April in the American Family Physician.

No outside funding was used for this project. No conflicts of interest were found.

Reviewed by: 
Review Date: 
April 2, 2013