## "Eliminating Medication Overload"

  
There is an overlooked pandemic of harm from the excessive prescribing of medications to older adults in the United States. While medications are beneficial for many people, excessive prescribing puts millions of people at a greater risk of harm than it benefits. For instance, there are nearly 1.3 million emergency department visits each year due to adverse drug effects; of those, 350,000 patients are hospitalized for further treatment ("Adverse Drug Events in Adults." 1). In addition, older adults, sixty-five years or older, visit emergency departments 450,00 times each year, more than twice, as often as, younger individuals ("Adverse Drug Events in Adults." 1). Moreover, these statistics are growing; the Lown Institute predicts that if nothing changes over the next ten years, medication overload will lead to 4.6 million hospitalizations of older Americans, and fifteen times as many outpatient visits for side effects from medications (1). Medication overload is primarily caused due to a culture of prescribing, a lack of knowledge among clinicians and patients, and a divided healthcare system. However, it is possible to reduce the over-medication of older adults through changes in the education and training of clinicians, raising awareness, and reducing pharmaceutical industry marketing to clinicians and patients.  
  
Patients and clinicians are all fixed in a culture of prescribing, connected to the belief that all health concerns can be cured by taking a pill. Numerous elements shape this culture of prescribing, and it affects the way clinicians and patients think about medications. Many clinicians prescribe medication knowing it is not needed to maintain a good relationship with patients. For instance, a study in 1998, that analyzed twenty-one general practitioners and seventeen patients consulted for a sore throat found that even though, "Doctors know that antibiotics do not help most sore throat sufferers but try not to jeopardize relationships with patients over this issue" (Butler 642). Moreover, the advertising of prescriptions also contributes to the culture of prescribing. Direct-to-consumer pharmaceutical advertising (DTCA) is legal in only two countries, the U.S. and New Zealand, but banned everywhere else as a health precaution. These advertisements encourage using medications, while utilizing lengthy, fast-spoken descriptions of side effects. Further, in 2002, the U.S. General Accounting Office estimated that eight million Americans requested and obtained prescriptions in response to DTCA (Mintzes 264). In order to minimize the effects of the culture of prescribing, public awareness needs to be raised about the harms of excessive prescribing. Additionally, a Eliminating Medications Through Patient Ownership of End Results (EMPOWER) study conducted on 2,665 individuals, sixty-five to a hundred years old, were given information about potential harms of sedative-hypnotics. This information led to sixty-two percent of participants to discuss deprescribing with a clinician and twenty-seven percent to discontinue chronic sedative-hypnotic use within six months (Turner 2692). Public health campaigns are required to increase awareness of the dangers of medication overload, while promoting shared decision-making to deprescribe, and countering the pharmaceutical industry's influence.  
  
Further, both clinicians and patients lack vital knowledge and skills to make educated medication decisions. Rarely are clinicians instructed on how to track and avoid excessive prescribing or how to deprescribe medication. There have been many advancements in the medical field, although the present system does not assist clinicians in learning this material. According to Friedman, "approximately 75,000 people died in 2005 because of inefficiencies in the healthcare system" (125). Due to the lack of training, clinicians frequently feel incapable of discontinuing patients' medications. In order to combat the lack of training, there must be clear clinical practice guidelines to follow for prescribing and deprescribing medication and performing prescription checkups. Additionally, the procedures must be well spread throughout the various healthcare settings.  
  
Moreover, our healthcare system is comprised of various healthcare specialists in different settings, leading to an increase in inappropriate medication given to patients. The U.S. healthcare system has grown to be highly specialized. As a result, primary-care providers struggle to function as such. Instead, specialists care for the patient's condition separately, usually without taking into account what different diseases or medication the patient has or is on. Due to specialization and a divided system, many patients lack a primary health care provider who knows and understands all of the medications the patient is on. Thus, prescriptions are often given to treat what comes across as a new medical condition, but is simply a side effect of another medication. This is known as a prescribing cascade and can lead to adverse medical reactions and death. Moreover, potentially inappropriate medication prescribing (PIM) is common and is worsened in older patients, when moving to and from hospitals and nursing homes. Patients are generally given medications to treat a critical, nonpermanent condition in the hospital. A study in 2014, by Medication Safety Researcher Tariq, Alhawassi found that more than one in every ten older patients in the hospital setting, experience an adverse drug reaction (ADR) either leading to or during their hospital admission (2079). In addition, during transitions to nursing homes, human restrictions, technical deficits, and organizational elements all play a role in PIM. A study in 2019, found that PIMS was relevant among fifty-seven percent of the 103 nursing home residents (Halvorsen 4). In order to reduce the increase of medication overload, the patient's primary care provider must have all essential information and perform prescription checks ups to decrease the risk of inappropriate medication prescribing.  
  
In sum, if the excessive prescribing of medication is not addressed, Americans will continue to face severe and life-threatening adverse drug effects. Action is needed immediately to reduce the harm that current practices are causing older individuals. Successfully tackling this problem can be done by changes in the education and training of clinicians, raising awareness to the public, and by reducing pharmaceutical industry marketing to clinicians and patients.  
  
Works Cited  
  
"Adverse Drug Events in Adults." Centers for Disease Control and Prevention, Centers for Disease Control and Prevention  
  
Alhawassi, Tariq M et al. "A systematic review of the prevalence and risk factors for adverse drug reactions in the elderly in the acute care setting." Clinical interventions in aging  
  
Butler, C C et al. "Understanding the culture of prescribing: qualitative study of general practitioners' and patients' perceptions of antibiotics for sore throats." BMJ (Clinical research ed.)  
  
Friedman, Deborah, et al. "US healthcare: a system in need of a cure." American Journal of Medical Research, vol. 3, no. 1, Apr. 2016, p. 125. Gale OneFile: Health and Medicine  
  
Garber, J., and Brownlee, S. Medication Overload: America's Other Drug Problem. Brookline, MA: The Lown Institute. 2019 DOI  
  
Halvorsen, Kjell H et al. "Assessing Potentially Inappropriate Medications in Nursing Home Residents by NORGEP-NH Criteria." Pharmacy (Basel, Switzerland) vol. 7,1 26.  
  
Mintzes, Barbara. "Advertising of Prescription-Only Medicines to the Public: Does Evidence of Benefit Counterbalance Harm?" Annual Review of Public Health, vol. 33, no. 1, 2012, pp. 259-277  
  
Turner, Justin P, and Cara Tannenbaum. "Older Adults' Awareness of Deprescribing: A Population-Based Survey." Journal of the American Geriatrics Society vol. 65,12 (2017)