The advances of modern medicine have provided benefits for many people. Our ability to treat life threatening bacterial infections (not viral illnesses) with antibiotics and our ability to surgically repair traumatic injuries are but two examples where modern medicine makes a big difference.
But there is never such a thing as a free lunch. Western medicine has excelled at dealing with acute illness and injury. If you have a broken leg you cannot meditate it better. If you have acute appendicitis, then dietary change is not going to fix it.
But when it comes to chronic conditions western medicine has not done so well. Chronic lifestyle related conditions like diabetes (type 2) and high blood pressure are not cured by medication – they are simply controlled to some degree.
And as people are living longer we tend to end up on more and more medications. Australian research has shown that 82% of those in residential aged care facilities are on at least seven different medications. And it was also found that up to 30% of hospital admissions in the over 75-age group are medication related. Of these, some three quarters were deemed to be preventable.
In the USA research was done on 5406 people aged over 85 with dementia who were in residential aged care. Some 70% had a do not resuscitate order in place. Yet over 50% were on at least one medication of “questionable benefit”. More than 20% were on a statin to lower cholesterol and 7% were on blood thinners.
The pattern may be similar in other counties. The purpose of any medical intervention is to improve the quality of life or to extend life expectancy. The closer we get to the end of our lives the less that extending life expectancy is likely to be relevant. This is underlined by the fact that virtually no research is done on the benefits of most medications in those over the age of 65.
I have personally seen 90 year olds sent out of hospitals on three new medications, which will achieve neither of the two key aims of any treatment.
Both the American and Australian reviews called for a reassessment of the use of medications in the elderly. The Australian group called for a greater emphasis (there is none at present) on “de-prescribing”.
The sentiment is absolutely correct. However, this is an awful jargon term! How about we focus on prescribing medication only if there is a benefit to the person. Or, to be even more precise, only take medication if the benefit outweighs the risk.
For example lowering blood pressure to “target” levels in the elderly may sound good. But if the blood pressure falls and the person faints and then breaks their hip we have done far more harm than good. The same applies if someone is dizzy as a side effect after taking an antidepressant (prescribed because they were grieving) and falls over.
There are countless more examples.
The bottom line is this. Too many of us (and not just the elderly) are taking too many tablets for too long. Every time a prescription is due for renewal, fundamental questions needs to be asked. Is the reason this medication was commenced still valid? Is this medication still doing more good than harm? Ultimately, is there still a valid reason to be taking it?
We will only get answers if we ask the questions.