Over the years working as a Registered Nurse in British Columbia, I must have given out a million pills. Now they are administered in blister packs and do not have to be pre-poured, but during the years prior to blister packs, it could take hours to pour medications in a large facility. Since we had a responsibility to know what we were administering to people, I also learned a fair bit about the drugs, and listened to people describe side effects and adverse reactions.
In long term care, there was a great deal of coaxing required to get people to take their medications. Often they would spat them out, no matter what they were mixed with. It was about the only reaction that warranted a notation of Ref. (for refusal) on the medication sheet. Nurses were expected to give them – and patients were expected to take them. End of story.
Since we are all aging and either looking toward retirement, or else have parents or grandparents who are seniors, it is a topic worth learning something about. The other thing for middle aged people to be aware of, is how to approach those coveted retirement years without the need for a dozen classes of prescription drugs to hamper your lifestyle. An ounce of prevention during middle age is worth a pound of cure down the road!
First of all, why so many drugs for seniors? We are told it is because seniors are prone to chronic disease. This is due to lifestyle factors and cumulative stressors on all systems of the body. I tend to think more than half the problem is due to prescription drugs. They cause more problems than they cure. If they cured anything, the prescription rates would be trending downward, not upward.
To give a few Canadian 2016 stats on the prevalence of over-prescribing; 65.7% of seniors were prescribed five or more different drug classes per year. 26.5% were prescribed ten or more drug classes, and 8.4% took a walloping fifteen drug classes.
It leaves me scratching my head, because although I took those percentages from the Canadian Institute for Health Information (CIHI) – it actually adds up to more than 100% (100.6%), which must be due to rounding the numbers. How is it that no one escapes being prescribed drugs after a certain age? How is it that (according to the stats) no one is prescribed less than five drug classes after the age of 65? If the Canadian health care system does collapse under all this pressure, maybe it would be the best solution for seniors after all. But, how would Big Pharma let such a thing happen anyway?
No wonder seniors are using up 40% of the health care resources. But there is a much bigger picture to look at. As soon as one prescription drug is the norm, the very next step is to add another. Why? Because all drugs cause side effects, and in many cases side effects are interpreted as a new condition. So instead of removing the offending initial drug, new drugs are added.
In looking at the distribution of the excess medications people take, it is kind of disturbing too. Women are prescribed more drugs than men. Lower income seniors, and those who live in rural areas are also prescribed more medications than those in urban areas. People who have higher incomes are prescribed fewer drugs overall, but they too, take way more than required. Among First Nations populations, more than 50% are prescribed more than ten drug classes. All of these prescriptions increase with age, with the highest numbers doled out in long term care facilities.
The top drug class prescribed to seniors, is statins for high cholesterol. They are also one of the few drugs that are prescribed regardless of income or location. A staggering 50% of all seniors take statins. Next to statins are the proton pump inhibitors, to treat GERD (gastrointestinal reflux disease), and ulcers. Following that are the beta blockers and calcium channel blockers to treat hypertension. Then there are the thyroid hormones to treat hypothyroidism, and a variety of drugs to treat insulin resistance leading to high blood glucose levels. Opioids are prescribed on a regular basis to 20% of seniors as well. Add to the list of frequently prescribed drugs, are sleeping pills, benzodiazepines, and antibiotics.
What drugs are considered most hazardous, enough to make the list of drugs that should definitely NOT be prescribed to seniors? Psychotropic drugs such as benzodiazepines, antidepressants, and antipsychotics are on the list of hazardous substances, and are to be avoided (at all costs). They have been proven to cause falls, increased fractures, and cognitive impairment, as well as an increased risk of adverse drug reactions. It makes me wonder why more doctors are not getting sued. In spite of the known hazards, these drugs are still commonly prescribed. Who is educating the doctors I wonder?
Apparently several interventions have been implemented to educate doctors and patients (if they still have enough cognitive and decision making functions after being immersed in a chemical soup for a period of time). Obviously the time to start thinking about these things is before you start taking the drugs, not after. Once the body adapts to certain drugs, especially those that interfere with functions of dopamine and the central nervous system, it requires carefully monitored detox to remove them from the system. If there are ten different drug classes to deal with, the complexity of making changes later on, makes it more like a game of Russian roulette than anything else.
How on earth is it possible that 100% of seniors need prescription drugs? Does half the population need statins? I find that hard to believe. But even if a person does have high cholesterol or high blood pressure, can’t he or she make changes in diet and lifestyle before being medicated? Our minds are doctored.
Personally, I do not intend to take any prescription drugs at all. To me – it’s like dodging a bullet. Such an attitude and decision can only be monitored over a long period of time, so it’s too early to tell! But surely the general public should be educated too, for their own sakes, as well as for their loved ones who are seniors. When an adult child of a senior sees a prescription for psychotropic drugs such as antipsychotics, benzodiazepines and antidepressants – they should be warning the senior and someone should be calling the doctor to find out what the heck is going on.
The trouble with the interventions they have implemented to educate doctors and patients on the hazards of all these drugs, the interventions have had little effect on clinical outcomes such as mortality, hospitalizations, ER visits, adverse reactions or health status. Sick eh?
One of the menial things I used to ponder when administering so many toxic medications, was to mindlessly ask myself – “why are so many of them brightly coloured?” They come in every colour of the rainbow, which means they also have an extra dose of something equivalent to acrylic paint thrown in, for some unknown reason. I guess the reasoning is along the same lines as why they make candy and popsicles so colourful. They must brighten someone’s day!
After statins, the next most prescribed drug class is the proton pump inhibitors. It kind of sounds like something a mechanic would do to fix a car, but nope – these are to inhibit the acid in your gut. These drugs are prescribed for GERD and stomach ulcers. 30% of seniors are prescribed this class of drugs. However prolonged use, (more than eight weeks) leads to a high risk of Clostridium difficile infection, bone loss and fractures. But how does a person who needs such a medication suddenly stop taking it after eight weeks? After a period of time, the body relies on the drug to mask symptoms, and the symptoms return with a vengeance once the drug is stopped.
The inappropriate and excessive drugging of seniors has been of increasing concern to practitioners, researchers, and organizations throughout Canada. These organizations include the Canadian Deprescribing Network, the Canadian Foundation For Healthcare Improvement, The Institute For Safe Medication Practices, the Canadian Safety Institute, and Choosing Wisely Canada. What have all these combined organizations accomplished? All the organizations, abstracts, meetings, interventions, analysis, and professional babble on the topic has decreased the overall prescribing by about 2% – which can be taken with a grain of salt!
Clearly the autonomy of the patient, and decision making by the patient while still cognitively intact, must be the first line of defence when it comes to putting a myriad of toxic substances into our systems. Why are people taking so many drugs? Do they specifically ask for them? Or do doctors suggest or push them on people?
The problem is much more complex than we realize. We have been sold a pill of hogwash we are expected to swallow without questioning, along with an unsavoury bill of goods. We are being drugged and merchandised to death. We have been indoctrinated to trust doctors instead of our own better judgement. The other factor is fear. What if I don’t take the prescribed drug? The other motivator or objective is to get relief from unpleasant symptoms. But, we have to start to “listen” to our bodies. Those symptoms are telling us to change something, not to cover it up.
Any symptom we get is a signal for us to pause and evaluate what is going on with our bodies. Many symptoms can be relieved through exercise and diet. We can treat infections with things like oregano oil and garlic. Blood sugar and blood pressure levels can be reduced through diet and exercise. Raw ginger can reduce inflammation. Olives interfere with and reduce histamine reactions, and so on.
All people should be encouraged to do their own research and take responsibility for their own health as much as possible. It is very difficult to challenge the judgement of doctors – yet why shouldn’t we? After all, we are the ones who are supposed to ingest the toxic mix and live with the consequences. Every single drug has adverse effects on the system. Sometimes those adverse effects are not immediately apparent, such as bone loss and early cognitive impairment. Almost all cause dry mouth and changes in digestive enzymes, which in turn alters the biome of the bacteria in the gut. All of them must be detoxified by the liver and kidneys. So the cascading chain of events secondary to these drug classes is beyond comprehension.
Avoiding prescription drugs might be achieved by avoiding going to doctors. Such advice leaves many people aghast. What about your yearly physical? What about mammograms and other screening tests? What about your cholesterol and blood pressure? Learn about it. Research all of it before you turn the rest of your life over to someone who is prone to over prescribing medications.
Keep in mind that this list and description of drug usage does not include over the counter medications. How many people add NSAIDs (such as Ibuprofen) or other OTC meds like Tylenol, Gravol, cough medication, and antihistamines as part of habitual usage? They might be available without a prescription, but they too, pack quite a punch when it comes to drug interactions and toxicity. Add to the mix, an over zealous attempt to include multiple supplements as some kind of method to improve health, when in fact, supplements can be as toxic as the rest of the pills and tinctures we are inclined to self-medicate with.
One of the aspects of opiate usage is in how much they are relied upon in end of life situations. They are sometimes needed for pain. But from experience, I know that nurses are expected to keep dying patients sedated whether they have pain or not. Often this is because of family members wanting to see their loved ones comfortable, and sometimes it is because health care practitioners have not come to terms with death and dying themselves, and therefore are prone to over sedating patients.
I have come to believe that dying patients should not be automatically sedated with opiates, and personally it would not be my choice, unless I was in agony. Many people who are dying sleep a lot anyway. When they do have wakeful periods, if there is no pain, those wakeful periods can be valuable time spent with loved ones.
For those who believe death is a transition, where the soul leaves the body and goes to another location (like the Bosom of Abraham) – who really wants to be drugged unconscious when going through that final adventure, and take the chance of missing the brilliant and beckoning white light at the end of a love filled tunnel? I hope to be wide awake when I die! Some people want to die in their sleep, but I think sudden death (without being overly drugged) – probably wakes people up. Otherwise they would need to send a chariot for us. Swing low – sweet chariot!
Nothing can compete with the natural processes of the body. We have incredible capacity to handle both living and dying without drugs. We have become reliant on drugs, as opposed to trusting our intuition, healing naturally, maintaining our own autonomy – and finding ways to avoid being a statistic on ten or more classes of drugs, before we make our final exit.
Quite frankly – the pharmaceutical companies don’t give a shit what happens to any of us. We have to stop allowing ourselves to be manipulated and used as human market potential to improve profit margins. They are truly making a killing. It’s the new black (force)!
Disclaimer – The opinions in this article are my own and not intended to undermine required treatment or medications. The information provided is to encourage research and seek methods of reducing over prescribing for seniors. The Beers list provides a comprehensive list of high risk medications to help inform the public. The link is https://www.guidelinecentral.com/summaries/american-geriatrics-society-2015-updated-beers-criteria-for-potentially-inappropriate-medication-use-in-older-adults/#section-420
Copyright Valerie J. Hayes and Quiet West Vintage (2019). Unauthorised use and/or duplication of this material without express and written permission from this blog’s author/owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Valerie J. Hayes and Quiet West Vintage with appropriate and specific direction to the original content.