If you have elderly parents, you are aware of their health problems and the many doctors they visit for those problems.
Our healthcare system is expensive partly because elderly patients require greater resources than most younger patients require. The problems begin at their primary doctors office who may be a geriatrician. Elderly patients are time consuming to treat and are often referred out to specialists. Once they leave their primary doctors office, the costs begin to rise dramatically as they go from specialist to specialist.
Years ago, primary care doctors would spend more time with patients if they needed it, because they could charge for their time. In todays environment, our system incentivizes doctors to refer time consuming problems to specialists. This fragmentation drives costs, may lower the quality of care while raising the cost of care. It also exposes older patients to the likelihood of having a risky procedure recommended to them that may not be necessary. For those politicians claiming to have a new system for lowering healthcare costs; they may wish to begin here.
The problem with overprescribing begins with specialists since it is likely that every specialist will give the patient a prescription. It is not unusual for elderly patients to have pages worth of prescriptions they were given by numerous specialists. This trend that has coincided with the Medicare drug coverage added in 2003 has driven the demand for drugs and the rising prices of many medications.
It is also likely that these medications interact and cause their own doctor created health problems which may land your loved one in the hospital. This fact alone drives the cost of healthcare higher while putting the elderly at risk.
Medscape, a well read internet site that doctor refer to is now suggesting that polypharmacy (the taking of 5 or more medications daily) is a serious health problem, and that there are eleven drugs they believe that doctors should remove their patients from. Medscape reported that in 2012, over 60% of patients over 65 were being given more than 5 medications. In the United States, we take more medications than in another other country, without any evidence that this is making us healthier. There is evidence that it is making us ill.
This happened to my mother who was in the hospital for pneumonia and the list of medications that she was taking was absurd. As a result, she felt ill, and was lethargic. I personally went through the 3 page list with her cardiologist and eliminated most of what was unnecessary, something the hospitalist should have done.
The medications are on the Beers Criteria published in the Journal of the American Geriatrics Society. The current list includes up to 30 medications that are overused, however, Medscape suggests the following need to be deprescribed immediately which include
Antibiotics prior to dental procedures
Proton Pump Inhibitors
Statins for Primary Prevention
Antimuscarinics for Urinary incontinence
Cholinesterase inhibitors for Alzheimer’s Disease
Muscle Relaxants for back pain
You can read the complete article at this link. You will have to sign up with Medscape to read the entire text.