November 13th, 2019
Medications that are safe for young and middle-aged adults to take may not be as safe for older adults. As we age, we lose some ability to process medications because of reduced kidney and liver function. Older people also generally weigh less than young and middle-aged adults, and have a higher proportion of fat in their body, which can cause certain drugs to stay in the body longer. These factors in combination increase older adults’ sensitivity to drug side effects, compared to younger adults.
While older adults are more susceptible to medication side effects, they are also more likely than younger adults to be taking multiple medications, which can lead to harmful adverse drug events. Some of these medications may not be appropriate for older adults to take, or may be too high of a dose.
Getting medications right is one of the primary concerns for older adults and their caregivers. But are they aware of the potential side effects that certain medications can cause? The John A. Hartford Foundation partnered with WebMD to conduct a survey of older adults and caregivers to find out more about their views on certain aspects of aging, including medication use.
The survey included responses from 2,361 randomly-selected patients age 65 or older, and 405 caregivers. The survey found that multiple medication use is common for older adults; 40% of caregivers reported that the individual in their care takes six or more different prescription drugs each day. Among older adults with more than six chronic conditions, one in three take more than ten drugs each day.
Despite the prevalence of multiple medication use, a significant proportion of both older adults and caregivers were unaware that certain medications are not recommended for older adults. Half of older adults and 45 percent of caregivers who responded to the survey were not aware that older adults should avoid certain medications, such as anti-anxiety drugs, sleep aids, over-the-counter anti-allergy medications, and certain diabetes medications. Only about 60% of older adults and 68% of caregivers knew that certain medications, such as anti-cholinergic drugs, anti-anxiety medications, and antipsychotic medications, can increase cognitive impairment or confusion. Even fewer patients and caregivers were aware that medications like sleep aids and blood pressure medications can increase the risk of falls.
Awareness of medication risks was not the same across patient race and ethnicity. Hispanic and Black respondents were about 15% less likely to know that older adults should avoid certain medications, compared to White respondents. About one-third of Hispanic adults responded that they were not at all familiar with medication risks, compared to about one-quarter of Black respondents, and one-fifth of White respondents. This awareness gap likely has an impact on the potential for deprescribing; according to the survey, Hispanic and Black respondents are less likely to have had discussions about unnecessary medications with their doctors, compared to White respondents. These results point to an important health disparity that may be leading to increased harm for older people of color.
Overall, only half of survey respondents said that a health care provider has talked to them about stopping medications. This is discouraging but not surprising, given that many clinicians do not have the time to engage in conversations about medications, nor are they reimbursed for doing so. Additionally, clinicians may expect patients and caregivers to resist deprescribing, so they do not attempt to bring up the subject. However, if more patients and caregivers are aware of potential drug harms, they may be more likely to express their concerns about medications and ask for a prescription checkup to discuss deprescribing.
The JAHF survey is enlightening, but there is still much we don’t know about patient and caregiver views on medications. The survey did not separate responses by age, so it is unclear how medication use and knowledge varies between adults in their 60s and 70s compared to very old adults and their caregivers. Nevertheless, the survey provides useful information about awareness of medication harms in older adults and caregivers, showing a potential avenue for public awareness campaigns, as well as highlighting the need to target older people of color in these campaigns.