Too Many Drugs Prescribed for the Elderly?

Many seniors are watching the debate in Congress over expanding Medicare prescription coverage. But one doctor is concerned that many of his older patients are already taking too many pills. He's on a crusade to reduce the number of drugs given to the elderly.

The pharmacy at the Hebrew Home for the Aged at Riverdale dispenses 6,000 prescriptions to its 800 residents every month.

Seniors here swallow an average of eight pills a day for ailments ranging from depression to heart disease. But last year, this nursing home hired a new physician, Dr. David Morris, who believes the elderly are being overmedicated.

"The philosophy generally is that the fewer the drugs the better," says Morris.

It's a philosophy that runs contrary to a medical establishment which embraces the avalanche of new drugs coming to market every year.

Last year alone drug sales jumped 15% to $145 billion. Seniors account for 34% of all prescriptions dispensed. Eighty-eight-year-old Lee Schwartz was taking a half-dozen medications before she came under Morris's care. Now, she only takes a water pill.

"I feel better since he took away all these pills . . . much better," says Schwartz.

Morris systematically questions every medication, and when he discovers in the fine print that a drug has been found to be of limited use, he will conduct his own trial.

"Your own trial with your own patient will determine whether they fit into the 30% for whom it is useful or the 70% for whom it is useless," says Morris.

He is especially concerned about the dangers associated with the overuse of drugs that treat depression and mood.

"Frequently medications given for anxiety can actually cause more anxiety or more confusion as well as sedate them too much," says Morris. "This extra bit of sedation often causes them to fall frequently."

Research shows that the more drugs a person takes, the higher the risk of complications.

The American Journal of Medicine published a study last year that reported 350,000 adverse drug effects in nursing homes each year. Dr. Jerry Avorn co-authored the study.

"We don't nearly know enough about dosing or even about drug effects in general in the elderly. There is really not any adequate requirement that drugs be tested in really old people or frail older people, " says Avorn, who works at Brigham & Women's Hospital in Boston.

And while Morris is concerned that there is insufficient data on many drugs given to the elderly, he does prescribe medication when it is needed.

"I'm not against medications. I'm against medications that they don't need or that are not effective," says Morris.

At 75, Dr. Morris is a maverick among the nine full-time attending physicians at this facility.

"He is an agent for change," says Dan Reingold, executive vice president of Hebrew Home for the Aged. "When Dr. Morris came on board he naturally encountered some resistance."

Reingold fully supports Morriss approach to medicine. He has watched the nursing home's pharmacy expenses skyrocket over the past decade and he is alarmed by current proposals to increase government Medicare subsidies for prescription drugs.

"We would be opening a floodgate to huge numbers of medications that would be available at virtually no cost to the consumer and that would create an incredible demand," says Reingold.

Pharmaceutical companies support drug subsidies and say their medications help people live longer and ultimately reduce health costs by keeping people out of hospitals.

But Morris firmly believes that physicians need to be sure the medicines they prescribe really work.

"I'm a patient advocate. My interest is in the patient," says Morris. "I don't consider the cost of medication, the need for drug companies to have a fat bottom line. If it's good for the patient, that's all I consider."
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