Why Dangerous Drugs Keep Being Prescribed to Older Americans Despite Warnings

Medical researchers sound the alarm. A commonly prescribed drug proves less effective for older patients or carries risks that outweigh benefits. Studies accumulate, confirming the findings. Medical associations revise guidelines. The drug lands on warning lists. The FDA issues black box alerts. Years pass.

Then researchers examine national prescribing data, expecting significant reductions. The reality proves disappointing. Use declines modestly at best. Sometimes it doesn’t decline at all. Occasionally, prescriptions actually increase.

“Medications are like barnacles,” said Michael Steinman, a geriatrician at the University of California-San Francisco and co-director of the U.S. Deprescribing Research Network. “They’re easy to start, but they can be hard to stop.”

The Growing Crisis of Polypharmacy

Over the past two decades, the use of multiple prescription medications among older Americans has nearly doubled. According to a recent brief published in JAMA, approximately 40% of adults aged 65 and older took five or more prescription medications within a 30-day period between 2017 and 2020. This represents a dramatic surge from approximately 20% reported between 1999 and 2000.

This phenomenon, known as polypharmacy, creates a dangerous cascade of risks. Each year, an estimated 1.5 million people in the U.S. are affected by medication errors. Older adults face particularly elevated risks due to the challenges of managing multiple daily prescriptions.

“Managing multiple medications can be challenging for individuals, and especially for older adults,” explains Mbonu Ikezuagu, M.D., chief quality officer at Froedtert ThedaCare Health, a Wisconsin-based nonprofit that helps to organize a patient’s care among multiple healthcare providers. “Each new prescription complicates daily medication routine and increases the risk of harmful errors if not monitored.”

Why Medical Inertia Persists

The failure to stop prescribing dangerous medications reflects what experts call medical inertia. This inertia stems partly from the time lag involved in disseminating research findings. Clinicians juggle countless priorities, and critical information may take considerable time to reach them.

However, the problem runs deeper than delayed communication. Steinman points to ingrained habits that develop over years of practice. “Clinicians and patients get used to treating conditions in certain ways,” he explained. Consequently, these patterns become difficult to break. Finding alternative approaches presents challenges, so practitioners default to familiar prescriptions.

Recent studies of three medications or classes of drugs widely used among older Americans illustrate the scope of this problem.

The Benzodiazepine Dilemma

Scientists began raising concerns about benzodiazepines more than 20 years ago. Prescribed for insomnia and anxiety, these drugs offer prompt relief. Nevertheless, the risks for older patients prove substantial.

Benzodiazepines-including Valium, Xanax, and Ativan-along with related “Z” drugs like Ambien and Lunesta create serious hazards. They may impair balance, coordination, and cognition, which can translate into falls, fractures, and motor vehicle accidents, according to Mark Olfson, a psychiatrist and epidemiologist at Columbia University.

Furthermore, patients taking opioids for pain face even greater dangers. In these cases, benzodiazepines can cause overdoses. “Once you’ve taken them for a period of time, you develop a dependence,” Olfson added.

Despite decades of warnings, these medications remain frequently prescribed. The drugs have earned placement on the Beers Criteria, an influential list of potentially inappropriate medications for older patients published by the American Geriatrics Society. Yet prescribing patterns continue largely unchanged.

Real-World Consequences

The impact of inappropriate prescribing has become increasingly evident through cases documented by healthcare professionals. One example, reported by the National Council on Aging, involves an 88-year-old woman named Alice Brennan who visited the emergency room in 2022 seeking treatment for neck and shoulder pain.

She was prescribed the muscle relaxant Flexeril to alleviate her pain, even though it can increase the risk of sedation and falls in geriatric patients.

Days later, at a routine appointment with her neurologist, the specialist immediately recognized the problem. The doctor instructed Brennan to stop taking the medication right away, which she did. However, when Brennan was later admitted to a rehabilitation center for an unrelated issue-gout in her knee-the facility began administering Flexeril again because it had become part of her medical record.

The Personal Toll of Overmedication

Individual stories reveal the daily burden polypharmacy creates. Carol Mitchell, diagnosed with Parkinson’s disease in 2010 at age 72, was prescribed carbidopa/levodopa. She swallowed the medication four times daily at precise intervals.

In subsequent years, doctors prescribed additional medications for skin issues, depression, motion sickness, anxiety, acid reflux, and early breast cancer. Her daughter discovered vials scattered throughout her bedroom, necessitating internet searches to identify each medication’s purpose.

“I don’t want to take medications like that. It’s too much, I think,” Carol, now 82, says. “You can’t leave the house because you’ve got all these medications to take.” Inevitably, she found herself missing doses of her Parkinson’s medication, leading to tremors, stiffness, and mobility difficulties.

Moving Toward Solutions

Addressing this crisis requires multiple strategies. Caregivers and healthcare providers serve as vital safeguards against medication risks. As the older population grows, better safety practices and error prevention strategies become essential.

Experts emphasize the importance of regular medication reviews. Clinicians must actively question whether each prescription remains necessary. Moreover, patients and families should feel empowered to raise concerns about medication regimens that seem excessive or cause concerning side effects.

The challenge extends beyond individual clinical decisions. Systemic changes in medical education, prescribing culture, and healthcare delivery models will prove necessary to protect vulnerable older adults from the dangers lurking in pill bottles throughout their homes. Until these changes take root, millions of seniors remain at risk from the very medications intended to help them.