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‘The doctor would not listen’: Japan faces off against over-prescription of drugs for seniors

by Tomoko Otake

Staff Writer

There’s no denying that, as you grow older, you are likely to visit doctors more often and have more medicine prescribed. According to 2014 data from the Health, Labor and Welfare Ministry, the amount of prescription drugs patients are given goes up as they age, especially after they turn 60.

As they get older, many people develop chronic conditions such as high blood pressure, diabetes and osteoporosis, for which they can be on medication for years.

In fact, it’s not uncommon for seniors to make rounds of two or three doctors regularly, causing a situation where local clinics turn into chanomi saron (tea salons), a venue for social gatherings rather than a provider of health care.

A 2015 ministry survey covering some 1,800 people with at least two conditions from a set list — high blood pressure, diabetes, high blood fat and dementia — showed that they were prescribed 5.8 medications on average. But nearly 30 percent of respondents were given seven medications or more. Among people with dementia and another chronic condition, 12.9 percent were prescribed 10 medications or more.

And that doesn’t include the number of over-the-counter drugs and dietary supplements people might be additionally taking.

But the problem with medicine is that more is not always better. Concerns are mounting that some seniors are over-drugged, making them more vulnerable to a range of drug-induced health problems, including depression, memory lapses, falls, constipation and loss of appetite.

Older people are also known to be more sensitive to certain drugs due to their slower metabolism, so doctors are being urged to start from smaller doses and monitor drug effects more carefully.

It is against this backdrop that a panel of experts under the health ministry is working to create comprehensive guidelines on how to prescribe to the elderly, and how to systematically cut back on “polypharmacy,” where the concurrent use of multiple medications causes adverse drug interactions.

The panel met last Friday, discussing a working draft for the guidelines set to be finalized next March. The guidelines, targeted for use by doctors, dentists, pharmacists and nurses, aim to facilitate coordination among medical professionals so patients undergoing care at different hospitals are evaluated based on their total medication intake and can receive guidance on how to stop polypharmacy.

At the meeting, panel member Keiko Higuchi presented results of a survey of 5,145 mostly healthy people over 65 that her nonprofit group conducted in September and October.

The survey, in which 69 percent of the respondents were female, showed that 25 percent wanted more explanation about the side effects of their drugs, while another 20 percent wanted the volume of their medications reduced.

One respondent wrote, “After I received surgery for a forefoot deformity at a university hospital, I was given nine medications. I said I didn’t need sleeping pills, stomach medicine and painkillers, but the doctor would not listen.”

The group’s survey also showed that many of the drugs end up not being taken. Nearly half of the respondents said they sometimes forget to take their medications, deliberately skip them for fear of side effects or save them for future use.

Higuchi, 85, who is a well-known social critic, said elderly people themselves are worried about polypharmacy, though they also depend on medications to maintain their health.

“For elderly people, medicine is something they cannot do away with; it’s almost like a traveling companion for their aging journey,” she said at a separate event in Tokyo held earlier this month. “Yet little has been known about the relationship between them. Do we really need handfuls of pills? Many are worried about side effects.”

A Matter of Health covers current research, technology and policy issues relating to health in Japan.