Overmedication in Nursing Homes in Baltimore

Overmedicating Seniors

As people age, they tend to develop more health conditions which may require medication. Overmedication describes the phenomenon of giving people too many different kinds or too high a dose of one or more prescription medications. While prescription medication, along with other medical technology, has allowed people to live to a more advanced age, there is a tendency to overprescribe heavy medications to the elderly which can cause unnecessary complications and can even be, in some circumstances, fatal.

The rate of overmedication in nursing homes can be hard to determine because it is difficult to know exactly when a medication is gratuitous, helpful, or absolutely necessary. Doctors may prescribe a particular medication because they have a relationship with a pharmaceutical company or because they are not familiar with more advanced or more recent alternatives to a particular prescription. One study performed by Brown University in Rhode Island reviewed 6 million seniors on Medicare Advantage plans in 2009 and “found that 21 percent received a prescription for at least one potentially harmful ‘high-risk medication.' Nearly 5 percent received at least two.”

High-Risk Medications

Certain drugs have been identified as “high-risk medications” using the AGS Beers Criteria and by the Pharmacy Quality Alliance because they have a tendency “to cause adverse drug events in older adults due to their pharmacologic properties and the physiologic changes of aging.” In addition, many of these high-risk drugs have less dangerous alternatives that can be prescribed. The Centers for Medicare & Medicaid Services (CMS) and the Healthcare Effectiveness Data and Information Set (HEDIS) have both, therefore, implemented measures to quantify and reduce the use of these medications in elderly populations. Commonly prescribed high-risk medications include:

  • Skeletal Muscle Relaxants such as carisoprodol, chlorzoxazone, cyclobenzaprine, metaxalone, methocarbamol, orphenadrine
  • Outdated antihistamines like Diphenhydramine and hydroxyzine
  • Oral estrogens
  • Non-benzodiazepine hypnotics such as Zolpidem, zaleplon, and Lunesta
  • The NSAID indomethacin
  • The antibiotic nitrofurantoin

Antipsychotics are a particularly dangerous and potent class of drugs that nursing home staff tend to overuse because of their ability to calm aggravated patients. The unauthorized use of antipsychotics in nursing homes is considered a chemical restraint and is illegal.

Warning Signs for Overmedication

Overmedication can have many different symptoms, depending on the patient's constitution, medical history, and current drug intake. In addition, many prescription drugs have a wide range of effects on the person who ingests them; one drug may work perfectly well for one patient while another patient, with a nearly identical health profile, may suffer severe side effects. For this reason, it is vital that nursing homes and doctors monitor patients on prescription medication and note physical, behavioral, and mental changes that may stem from prescription medication, especially for the first few months of a drug regimen or when a regiment is altered in some way. For concerned family members, signs of overmedication in elderly patients include

  • Sudden reclusiveness and withdrawal from friends and even family members
  • Fatigue and exhaustion
  • Oversleeping
  • Unexplained medical conditions, such as heart failure, seizures, high or low blood pressure, or migraines
  • State of confusion or disorientation
  • Physical complications such as dry mouth or ulcers
  • Erratic behavior or unexplained changes in personality
  • Hallucinations
  • Dizziness or falls in patients who are usually mobile

Preventing Overmedication

Health issues arising from advanced age often require complex and holistic approaches in management and healing. Unfortunately, in the age of prescription medication, doctors and/or nursing homes may be inclined to push medication on patients as a way of suppressing an underlying problem. Often, medications only treat symptoms of health conditions, such as high blood pressure or pain, without addressing the origin of these symptoms.

For older residents and their family members who are concerned with the possibility of overmedication, there are certain steps you can take to ensure that medication is only prescribed when it will provide a patient with necessary support. The Food and Drug Administration (FDA), for example, provides guidelines for how to speak with a physician and pharmacist about the prescription medications that they advise you to take. Questions they advise you to ask your doctor when a medication is prescribed that may help patients avoid overmedication include:

  1. How and when do I take the medicine and for how long?
  2. Can it be taken with over-the-counter medicines? If so, when?
  3. What your doctor means by "as needed."
  4. Will any tests or monitoring be required while I am taking this medicine? Do I need to report back to the doctor?
  5. What are the possible side effects and what do I do if they occur?
  6. When should I expect the medicine to start working, and how will I know if it is working?
  7. Will this new prescription work safely with the other prescription and over-the-counter medicines or dietary supplements I am taking?

In addition, it is advised to ask the pharmacist for any information you feel that the doctor did not explain clearly, asking questions such as:

  1. Do you have a patient profile form for me to fill out? Does it include space for my over-the-counter drugs and my dietary supplements?
  2. Is there written information about my medicine? Ask the pharmacist if it's available in large print or in a language other than English if you need it.
  3. What is the most important thing I should know about this medicine?

Protecting the Elderly from Overmedication

Overmedication is a systemic problem that can seem overwhelming to try to combat. However, if you believe that your loved one is being overmedicated, it may signal an underlying issue with the nursing home's ability to provide a reasonable standard of care to their residents. Nursing homes that rely on medication to subdue their residents or "fix" health problems that require more patient, holistic approaches may be understaffed or undertrained. This leaves their residents vulnerable to other forms of physical, verbal, or sexual abuse, as well as neglect.

To talk to an attorney about your case today, call Charles Gilman and Briggs Bedigian at 800.529.6162 or contact them online. The firm handles cases in Maryland, Pennsylvania, and Washington D.C.

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