A new study has found that medications are more often injurious than delay or failure to diagnose or treat an illness. Prescription meds are more dangerous to the elderly than minor surgical procedures, dental treatment, injections, vaccinations, physical therapy or chiropractic.
What is worse is that medications were responsible for 72% of treatment injuries that caused death or permanent disability in the elderly (over age 65). For the age group 18-65, medications were still the top cause of treatment-related injury, at 58%.
The study by researchers in New Zealand looked at the patient records for all ages across a 4-year period. Antibiotics were the number one type of drugs responsible for treatment injuries in all age groups. Antibiotics caused 82% of medication injuries in children, 57% of medication injuries in 18 to 65 year olds, and 51% of all medication injuries in persons over 65.
One of the most commonly treated conditions in the elderly is urinary tract infection. In fact, many doctors prescribe an antibiotic for the presence of bacteria in the urine, even if the patient is not showing any signs of an actual infection. This leads to overuse of antibiotics, and is in violation of national infectious disease standards. The guidelines advocated by the Infectious Diseases Society of America specify that not all elderly patients need an antibiotic just because bacteria are found in a urine sample. A study reported in 2011 showed that holding off from prescribing antibiotics to the elderly until and unless symptoms appear did not result in any complications (such as kidney infection) nor were there increased hospitalizations or deaths.
There are some flaws to the current drug injury study, which was limited to what was written in the actual medical records. For example, psychotropic medications (such as antidepressants and antipsychotics) are well known to have frequent adverse effects, specifically increased falls and premature death in the elderly. However, if the treating doctor did not enter this into the chart, it was not counted in the study. The psychiatric drug category is very underrepresented in the study results.
Several factors may drive this underreporting, not the least of which is the fact there is a stigma to causing a psychiatric-rug related injury, but antibiotic injuries carry little to no such risk of blame or malpractice claims. In addition, mental side effects of drugs are often mistakenly chalked up to progressive dementia in the elderly, with doctors typically taking no responsibility for possibly having caused the decline in their overmedicated patients. Despite black box warnings on antipsychotic drug label about causing premature death in the elderly, nearly 1/3 f all nursing home patients are prescribed these drugs.
In another example, doctors typically underreport the aggravating or causative factor of adverse drug effects that occur slowly, and might not be as obvious as a dramatic antibiotic-related allergic reaction. About 40% of the US adult population is on cholesterol lowering mediations, with unknown incidences of statin-related muscle damage, dementia and cancer.
It is especially important to be a questioning advocate for an elderly debilitated person. Insist on informed consent, including the information of the reasonable alternatives such as the consequences of no treatment at all. According to this study, no treatment or delayed treatment caused far less injuries than medications.
Learning From No-Fault Treatment Injury Claims to Improve the Safety of Older Patients. Katherine Ann Wallis, Ann Fam Med September/October 2015 vol. 13 no. 5 472-474
US Food and Drug Administration. Public Health Advisory: Deaths with Antipsychotics in Elderly Patients with Behavioral Disturbances. FDA Alert [4/11/2005]. http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/DrugSafetyInformationforHeathcareProfessionals/PublicHealthAdvisories/ucm053171.htm.