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American Medication Use Continues to Increase

Published December 11, 2015 3:08 PM by Brian Garavaglia

A recent study reported in the Journal of the American Medical Association found a sobering trend: An apparent increase in the usage of prescription medication over a decade-long period. The study was done respectively, analyzing data from the National Health and Nutrition Examination Survey database from 1999 to 2012. It contained the survey results of approximately 38,000 individuals. The study found a significant increase in the number of prescriptions medications that were used over this period of time.

During this decade-long period, a period that goes from 1999 to 2012, prescription drug use continued to increase. The percentage of the adult population reporting prescription drug use in 1999-2000 was 51%. This increased during the 2011-2012 period to 59%. However, more important than just the nominal increase in usage was the increase in the population according to age. As individuals became older, prescription drug use generally increases. However, the study found that adults are now using an increasing number of prescription drugs as compared to a decade ago. Over this period of time those aged 40 to 64 who used one or more prescription medications increased from 57% for the 1999-2000 period to 65% during the 2011-12 period. For those who were 65 years of age and older, a 6% increase was found to exist, increasing from 84% to 90%.

However, even more disconcerting was the increase in polypharmacy use. Polypharmacy use was defined as the use of five or more prescription drugs used by an individual at one time. Polypharmacy use for those 40 to 64 increased from 10 to 15%. However, for those who were over 65, polypharmacy use increased from 24 to 39% over this approximate decade under examination. This becomes a statistic that is important to take note of, especially due to the number of hospital admissions among older adults that is due to polypharmacy use. Furthermore, this is of particular concern since as one ages the potential sensitivity toward medications can also increase, leading to many forms of adverse reactions. These adverse effects are related to the pharmacokinetic changes in the body, especially changes in the ability to metabolize medications. Generally speaking, as individuals age the body’s ability to breakdown and eliminate many of these medications is reduced. Moreover, changes in the body’s composition, especially in fat and fluid composition, can dramatically alter the effects of many prescription drugs, making older adults more vulnerable to adverse drug effects, especially as polypharmaceutical use is increased.

In examining the medications that led to this increase, antihypertensives played one of the largest roles. Over the period of time that was examined by the study, antihypertensives increased from 20 to 27%. Drugs used to treat cholesterol and triglyceride levels, antihyperlipidemics, increased approximately 10%, from 6.9 to 17%. Narcotics, which are major opioid pain medications of the morphine-type classification, increased from 3.8 to 5.7%. Antidiabetic medications increased in use from 4.6 to 8.2%. In addition, antidepressant medications witnessed an increase from 6.8 to 13%. This is not all of the medications as well as their associated increases that were found by the study. However, it should nevertheless provide some understanding of the growing amount of medication usage that is found in our society in general, and among the older adult population in particular. Furthermore, with this increase in the number of medications that is being used among the older adult population, especially the level of polypharmacy usage that exists, come an increasing problem of medication management and its increasing therapeutic complexity. Moreover, one has to be increasingly mindful of the level of medication usage found among the older adult population coupled with the differential pharmacokinetics that often play a role in many older adult’s treatment regimes, which all too frequently is overlooked, leading to adverse reactions and unnecessary hospitalizations.

The study found that almost 40% of the United States population, 65 and over is currently taking five or more prescription medications. The elderly have consistently had the highest rates of prescription drug use, so this in itself is not surprising given their level of morbidity. However, apparently this part of the population is now taking a higher average amount of medications than ever before.  With each additional medication the complexity for medical management increases along with the potential adverse effects that are faced by the elderly. Furthermore, the study did not look at other factors such as over-the-counter medication use and the current increase in alternative herbal supplements that further compound the complexity of adverse drug occurrences happening.

Given the results of the study, especially the increasing polypharmacy use that was found to exist, Alex Macario MD, writes, “The important finding of polypharmacy raises other crucial questions for policymakers and health systems, such as whether a primary physician is managing the patient’s multiple medications to ensure that each is warranted and that the combination is optimal.” As the litany of medications increases, not only does the mismanagement of medication use increase among the elderly taking the medications, but also among the physician who is trying to manage the medications as well. They may often not be totally aware of the possible adverse interactive effects that could possibly exist among all the medications. In addition, since many physicians often have time limitations that exist with the elderly patients they see, this further limits their ability to often properly investigate whether any additional medication could possibly lead to an adverse drug occurrence happening if prescribed.  

In a culture that is often looking for quick fixes, medications are often thought to be our best answer. For most issues prescription medications are often prescribed judiciously. However, part of the answer to our escalating rate of drug use may also be due to the “medication quick fix culture” that has not only become inculcated into the mindset of the elderly community, but also among the professionals who serve this community. With rates of obesity increasing, a continued reliance on fast food, and a continuous amount of poor lifestyle choices that aid in advancing diseases as we age, we have come to think that there is always some pill that can be found that can reverse everything that has cumulatively led to many of our illnesses. With a culture that continues to emphasize therapeutic intervention rather than prevention, looking for a medication to reverse and correct, rather than other strategies to prevent in the first place has been the prevailing mantra. In an era when we are experiencing runaway medical costs, especially on the pharmaceutical level, individuals are inundated with drug advertisements encouraging them to run to their physician and request the advertised drug. Furthermore, in an era of patient competition, many physicians often readily capitulate to the requests of their elderly patients for the medications that they request.  

Therefore, what the study shows is more than just an increasing amount of prescription medication use. It is reflecting many of the cultural aspects regarding health, lifestyle, and intervention that we have come to casually acquiesce to. It is not just indicating a polypharmaceutical use increase; it is indicating a quick-fix cultural mindset that if not controlled will continue to led to escalating costs, heightened pharmaceutical use, and potentially increasingly life-threatening complications for our population.

References:
1. Macario, A (2015). Are Americans Taking Too Many Medications?  Medscape, http://www.medscape.com/viewarticle/854549?nlid=91877_1521&src=wnl_edit_medp_wir&uac=87637DR&spon=17&impID=900277&faf=1

 

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posted by Brian Garavaglia

1 comments

In a fast-paced world the quick-fix culture prospers. Almost half the population are drug addicts in a way or another, "legal" or "illegal".

Robert Greene May 9, 2016 12:35 PM

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    Brian Garavaglia, PhD
    Occupation: Long-term care administrator
    Setting: Sterling Heights, Mich.
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