Dominick Bailey sat at his computer, scrutinizing the medication lists of patients in the geriatric unit.
A doctor had prescribed blood pressure medication for a 99-year-old woman at a dose that could cause her to faint or fall. An 84-year-old woman hospitalized for knee surgery was taking several drugs that were not meant for older patients because of their severe potential side effects.
And then there was 74-year-old Lola Cal. She had a long history of health problems, including high blood pressure and respiratory disease. She was in the hospital with pneumonia and had difficulty breathing. Her medical records showed she was on 36 medications.
“This is actually a little bit alarming,” Bailey said.
He was concerned about the sheer number of drugs, but even more worried that several of them — including ones to treat insomnia and pain — could suppress Cal’s breathing.
An increasing number of elderly patients nationwide are on multiple medications to treat chronic diseases, raising their chances of dangerous drug interactions and serious side effects. Often the drugs are prescribed by different specialists who don’t communicate with each other. If those patients are hospitalized, doctors making the rounds add to the list — and some of the drugs they prescribe may be unnecessary or unsuitable.
“This is America’s other drug problem — polypharmacy,” said Dr. Maristela Garcia, director of the inpatient geriatric unit at UCLA Medical Center in Santa Monica. “And the problem is huge.”
The medical center, where Bailey also works, is intended specifically for treating older people. One of its goals is to ensure that elderly patients are not harmed by drugs meant to heal them.
That work falls largely to Bailey, a clinical pharmacist specializing in geriatric care.
Some drugs can cause confusion, falling, excessive bleeding, low blood pressure and respiratory complications in older patients, according to research and experts.
Older adults account for about 35 percent of all hospital stays but more than half of the visits that are marred by drug-related complications, according to a 2014 action plan by the U.S. Department of Health and Human Services. Such complications add about three days to the average stay, the agency said.
Data on financial losses linked to medication problems among elderly hospital patients is limited. But the Institute of Medicine determined in 2006 that at least 400,000 preventable “adverse drug events” occur each year in American hospitals. Such events, which can result from the wrong prescription or the wrong dosage, push health care costs up annually by about $3.5 billion (in 2006 dollars).
And even if a drug doesn’t cause an adverse reaction, that doesn’t mean the patient necessarily needs it. A study of Veterans Affairs hospitals showed that 44 percent of frail elderly patients were given at least one unnecessary drug at discharge.
“There are a lot of souvenirs from being in the hospital: medicines they may not need,” said David Reuben, chief of the geriatrics division at UCLA School of Medicine.
Some drugs prescribed in the hospital are intended to treat the acute illnesses for which the patients were admitted; others are to prevent problems such as nausea or blood clots. Still others are meant to control side effects of the original medications.
Pharmacist Dominick Bailey goes over Harriet Diamond’s medications. Diamond, 84, was hospitalized in the geriatric unit for knee surgery. (Heidi de Marco/KHN)
University of California, San Francisco researcher and physician Ken Covinsky, said many doctors who prescribe drugs in hospitals don’t consider how long those medications might be needed. “There’s a tendency in medicine every time we start a medicine to never stop it,” Covinsky said.
When doctors in the hospital change or add to the list of medications, patients often return home uncertain about what to take. If patients have dementia or are unclear about their medications, and they don’t have a family member or a caregiver to help, the consequences can be disastrous.
One 2013 study found that nearly a fifth of patients discharged had prescription-related medical complications during their first 45 days at home. About 35 percent of those complications were preventable, and 5 percent were life-threatening.
UCLA hired Bailey about three years ago, after he completed a residency at University of California, Davis. The idea was to bring a pharmacist into the hospital’s geriatric unit to improve care and reduce readmissions among older patients.
Speaking from his hospital bed at UCLA’s Santa Monica hospital, 79-year-old Will Carter said that before he was admitted with intense leg pain, he had been taking about a dozen different drugs for diabetes, high blood pressure and arthritis.
Doctors in the hospital lowered the doses of his blood pressure and diabetes medications and added a drug to help him urinate. Bailey carefully explained the changes to him. Still, Carter said he was worried he might take the drugs incorrectly at home and end up back in the hospital.
Lola Cal, 74, was hospitalized with pneumonia at the UCLA Medical Center in Santa Monica. Cal’s medical records showed she was taking 36 medications at the time she was admitted. (Heidi de Marco/KHN)
“I’m very confused about it, to tell you the truth,” he said after talking to Bailey. “It’s complicated. And if the pills are not right, you are in trouble.”
Having a pharmacist like Bailey on the team caring for older patients can reduce drug complications and hospitalizations, according to a 2013 analysis of several studies published in the Journal of the American Geriatrics Society.
Over a six-month stretch after Bailey started working in UCLA’s Santa Monica geriatric unit, readmissions related to drug problems declined from 22 to three. At the time, patients on the unit were taking an average of about 14 different medications each.
Bailey is energetic and constantly on the go. He started one morning recently with a short lecture to medical residents in which he reminded them that many drugs act differently in older patients than in younger ones.
“As you know, our elderly are already at risk for an accumulation of drugs in their body,” he told the group. “If you put a drug that has a really long half-life, it is going to last even longer in our elderly.”
The geriatric unit has limited beds, so older patients are spread throughout the hospital. Bailey’s services are in demand. He gets paged throughout the day by doctors with questions about which medications are best for older patients or how different drugs interact. And he quickly moves from room to room, reviewing drug lists with patients.
Bailey said he tries to answer several questions in order to determine what’s best for a patient. Is the drug needed? Is the dose right? Is it going to cause a problem?
One of his go-to references is known as the Beers list — a compilation of medications that are potentially harmful for older patients. The list, named for the doctor who created it and produced by the American Geriatrics Society, includes dozens of medications, including some antidepressants and antipsychotics.
When he’s not talking to other doctors at the hospital, Bailey is often on the line with other pharmacists, physicians and relatives to make sure his patients’ medication lists are accurate and up to date. He also monitors patients’ new drugs, counsels patients about their prescriptions before they are discharged and calls them afterward to make sure they are taking the medications properly.
“Medications only work if you take them,” Bailey said dryly. “If they sit on the shelf, they don’t work.”
Bailey explains medication changes to patient Will Carter in May. The 79-year-old was admitted to the hospital with intense leg pain and worries he might mix up his medicine after he is discharged. (Heidi de Marco/KHN)
That was one of his main worries about Cal, the 74-year old with chronic obstructive pulmonary disease. Standing at her bedside, Bailey pored over the list of 36 drugs. Cal told him she only took the medications that she thought seemed important.
Bailey explained to Cal that he and the doctors were going to make some changes. They would eliminate unnecessary and duplicate drugs, including some that could inhibit her breathing. Then she should take as prescribed all of the medications that remained on the list.
Bailey said he’s constantly weighing the risks versus the benefits of medications for elderly patients like Cal.
“It is figuring out what they need,” he said, “versus what they can survive without.”
–Anna Gorman, Kaiser Health News
This story was reported while its author, Anna Gorman, participated in a fellowship supported by New America Media, the Gerontological Society of America and The Commonwealth Fund. KHN’s coverage of aging and long-term care issues is supported by a grant from The SCAN Foundation, and its coverage of late life and geriatric care is supported by The John A. Hartford Foundation.
Born and Raised Here says
This is a Pharmacy and Doctor driven racket. We need to crack down on this.
Sherry says
This story should be read carefully and completely absorbed and understood by each one of us. Because, if we are fortunate enough to live a long life, we personally could be put in a situation where we are given medications that are putting us at great risk, instead of helping us!
At the risk of sounding pretty cynical, I can say through my own personal experience from reading literally thousands and thousands of medical charts during my 11 years as a health insurance underwriter, curing you is no longer the number one priority of many physicians. . . Making a Profit Is! And, it is much more profitable to “treat” you than to “cure” you!
Here are a couple of disconcerting points for you to research and strongly consider:
1. There are very few General Practitioners any more. You see, it is much more “profitable” for you to be evaluated/treated by several specialists, rather than have one “personal” physician who actually knows your entire medical history very well, and so can care for you holistically. Our bodies are NOT discreet/isolated fragments of tissue/blood/bones/internal organs! Rather the miracle of the human body is that each one is comprised of a very complex completely “integrated” whole, where every cell and system impacts all others to some degree.
2. Although the technology for the VITAL documentation and sharing of “medical charting” data between specialists is certainly at the finger tips of our medical community, it is NOT a priority in developing a medical practice. Some doctors prefer to keep their data about you proprietary. . . not necessarily to control your care, but to control the “profit” of your care.
3. This lack of communication/coordination between specialists and hospitals is the same is trying to rebuild a house without a “licensed expert general contractor”. Often, the “right hand doesn’t know what the left hand is doing”! Our government regulates and requires a “licensed general contractor” for the construction of commercial buildings, yet there obviously are not these same protections for our citizens when it come to the medical industry.
4. BIG PHARMA has sales people beating down the doors with “incentives” to physicians to prescribe their particular drug. That relationship is huge business with massive “billion dollar” profits for the pharmaceutical industry! Where do you think your personal well being stacks up against billions of dollars of profit?
5. Good nutrition is the vital fundamental key to good health, yet our medical schools teach very little about that essential element of medical treatment. Why? Because there’s no profit motive!
Each of us would be well advised to create our own personal team of medical care advocates to make sure our lives are not put at risk by being over tested and over medicated simply because some insurance company somewhere will pay for it! Does that mean becoming educated on what is done to your body, and then standing up for yourself. . . you bet ya! Aren’t you worth it?
Rick G says
And yet another way hospitals and Big Pharma can scam Medicare.
Donald Trump's Tiny Fingers says
I think this is less “big pharma” and more “bad doctoring.” As it stands, the current medical model is that people go to the doctor, they’re diagnosed with some condition requiring medication, the doctor prescribes a med to treat the condition, and the med is filled by a pharmacist somewhere.
The problem with this model is that doctors aren’t trained to the same level as pharmacists are when it comes to medication – for example, if you look at the path to MD laid out by UCF’s medical school, you will see no classes that deal specifically with drugs. What needs to happen instead is that you leave the doctoring to the doctors and the medications to the pharmacists. Doctors need to consult with pharmacists, who then recommend a treatment protocol – that way you avoid being prescribed 85 pills with horrible cross interactions.
Kip says
Yet the average life expectancy is higher than ever before, so people are living longer………weird? With all this polypharmacy going on you would think it would be lower, physicians would be killing people by overdose.
Tired of it says
This is an interesting article. The matter now is that under Obama Care soon it won’t be a matter of treating some elderly folks with certain illnesses. They will just let them die.
Sherry says
@Tired of it. . . please cite a “credible” source for your ridiculous and inflammatory statement!
Tired of it says
Because of Obama Care many hospitals are being penalized for readmitting seniors for illnesses. Thus many more are getting inferior care and dying because of it.
http://nypost.com/2014/05/18/obamacare-risks-for-the-elderly/
Sherry says
Yes. . . that’s what I thought and why I said “credible” . . . the NY Post is right up there with the Enquirer and FOX when it comes to conspiracy theories and tabloid journalism . . . even Wikipedia shows this critique:
The Post has been criticized since the beginning of Murdoch’s ownership for sensationalism, blatant advocacy, and conservative bias. In 1980, the Columbia Journalism Review stated “the New York Post is no longer merely a journalistic problem. It is a social problem – a force for evil.”[36]
Perhaps the most serious allegation against the Post is that it is willing to contort its news coverage to suit Murdoch’s business needs, in particular that the paper has avoided reporting anything that is unflattering to the government of the People’s Republic of China, where Murdoch has invested heavily in satellite television.[37]
Critics say that the Post allows its editorial positions to shape its story selection and news coverage. Post executive editor Steven D. Cuozzo has responded that the Post “broke the elitist media stranglehold on the national agenda.”
According to a survey conducted by Pace University in 2004, the Post was rated the least-credible major news outlet in New York, and the only news outlet to receive more responses calling it “not credible” than credible (44% not credible to 39% credible).[38]
The Public Enemy song “A Letter to the New York Post” from their album Apocalypse ’91…The Enemy Strikes Black is a complaint about what they believed to be negative and inaccurate coverage blacks received from the paper.
The Post’s coverage of the murder of Hasidic landlord Menachem Stark prompted outrage from Jewish communal leaders and public figures.[39]
Rick G says
Its not called Obama care for those over 65. Its Medicare and its been around for over 50 years. Hospitals and Doctors have learned ways to scam it (see our own Governor) over the years.
Sherry says
Good point Rick G. . . I would add that Big Pharma, medical practitioners and hospitals all focus on how to use every loophole and treatment reporting code to scam EVERY insurance plan in every way! Which, in turn, causes health care insurance premiums to increase for EVERY kind of plan. . . because the insurance companies are also laser focused on “Maximizing Their Profits”.
This is a prime example of American Billionaire Greed! Which exposes the corrupt, dark side of “Capitalism”! We should not be allowing extremely vital public services to be completely controlled by “profit centers”! When we do, human beings are left by the wayside in favor of amassing more and more profits for the criminal billionaires at the top.
Yet, here we are. . . considering one of the “worst” to be President of our country!
Sherry says
BTW. . . this “over drugging” and over testing, and massive lack of oversight and coordination in our medical community CANNOT be blamed on Obamacare! From my professional experience, iIt has been going on for well over 30 years!