PRESS RELEASE: Growing epidemic of medication overload impacting millions of older Americans

By Judith Garber | April 2, 2019

Lown Institute calls for national action plan to address overprescribing

For immediate release: April 2, 2019

In 2018, 5 million older Americans—one in ten—sought medical attention as a result of a serious reaction to medication. Over the past decade, the rate of emergency room visits for adverse drug events (ADEs) among older Americans nearly doubled.

In response to this alarming trend, the Lown Institute is calling for a national plan of action to tackle overprescribing.

“Medication overload is causing widespread yet unseen harm to our parents and our grandparents,” said Lown Institute Senior Vice President Shannon Brownlee at a press conference. “It is every bit as serious as the opioid crisis, yet the scope of medication overload remains invisible to the vast majority of families and patients, most policymakers, and even many health care professionals.”

In a report released today, Medication Overload: America’s Other Drug Problem, the Lown Institute documents a steep rise in the number of medications taken by older Americans, and a parallel rise in serious ADEs, such as delirium, dizziness, and bleeding that can lead to loss of mobility, falls, hospitalization, and in some cases, death.

Among the most telling statistics, the report cites:

A 300 percent increase over two decades in the number of older adults taking five or more medications. More than 40 percent of older Americans take five or more medications, putting them at significant increased risk for an ADE.
In 2018, ten million older adults (one in five) experienced an ADE, five million sought medical attention; 280,000 hospitalizations resulted from ADEs.
The rate of emergency department visits for ADEs doubled between 2006 and 2014, from 5 to 10 per 1000 older adults (194,000 to 450,000 ED visits).

If nothing is done to address this growing crisis, over the next decade, ADEs will result in 74 million outpatient visits, 4.6 million hospitalizations, and 150,000 premature deaths among older Americans, costing our health system $62 billion.

This is a systemic problem, says Brownlee, that requires more than the piecemeal approach we’ve taken in the past. “While some clinicians and pharmacists are trying to reduce the burden of medications on their individual patients, no health care professional group, public organization, or government agency to date has formally assumed responsibility for addressing this national problem. That must change.”

“The data in this report should serve as a clarion call for a national strategy to address medication overload,” said Dr. Terry Fulmer, president of The John A. Hartford Foundation. “We have identified appropriate prescribing and medication management as one of the four pillars for age-friendly health systems. It is crucial to the health and well-being of all older adults.”

In the report, the Lown Institute examines the way in which the culture of medicine and the fragmented health care system drive overprescribing. “Both clinicians and patients overestimate the benefits of medications and underestimate the harms. The prevailing attitude is ‘a pill for every ill,’” said Judith Garber, co-author of the report with Brownlee.

Because this is a systemic problem, a comprehensive set of solutions is needed, including interventions in medical education and training, research, pharmaceutical marketing, and electronic medical records.

Of critical importance is better care coordination for older Americans, including regular prescription checkups, in which a clinician and patient review all of the patient’s medications and make adjustments as needed.

“Annual prescription checkups would be ideal,” said Dr. James Rudolph, a professor of medicine and health policy at Brown University and the director of the Center for Innovation in Geriatric Services at the Providence, RI, Veterans Administration. “Patients are also acutely vulnerable during care transitions. At the very least, when patients enter or leave a hospital or long-term care setting, they should have a comprehensive prescription checkup.”

“Seniors are aware that they are being prescribed too many medications,” said Johanna Trimble, a patient advocate who sits on the steering committee of the British Columbia Polypharmacy Risk Reduction Initiative. “Senior organizations are hearing from their constituents that they are increasingly experiencing serious side effects that affect their health and quality of life.”

Support for this research was provided by the Gordon and Betty Moore Foundation.

For further information, contact:
Aaron Toleos
AToleos@lowninstitute.org
(978) 821-4620

About the Lown Institute: Founded by world-renowned cardiologist and humanitarian Bernard Lown, the Lown Institute is a nonpartisan think tank dedicated to transforming America’s high-cost, low-value health system. The institute conducts research, generates bold ideas, and creates a vision for a just and caring system of health that works for all.

To eliminate medication overload, serious cultural, educational, and policy changes are needed. This action plan offers recommendations for policymakers, health care institutions, clinicians, and patients across five key categories to reduce harm from multiple medication use. Suggested Citation: Eliminating medication overload: A national action plan. Working Group on Medication Overload. Brookline, MA: The Lown Institute, 2020. DOI: https://doi.org/10.46241/LI.YLBW4885

Pharmaceutical marketing is a significant factor in the growing public health crisis of medication overload, which puts millions of older adults at risk of preventable harm and premature death. This issue brief provides recommendations to reduce pharmaceutical industry influence by limiting pharma sales rep visits to clinicians and direct-to-consumer advertising.

This issue brief provides recommendations for clinical practice guidelines and electronic health records that would give clinicians the information they need to appropriately prescribe and deprescribe.