Diabetes Self-Management Blog

Roughly 75% of older Americans have multiple chronic conditions, and more than 20% of them are taking medicines that work at cross-purposes — improving one of their conditions while worsening another — according to new a new study in the journal PLoS One.

To determine the prevalence of this “therapeutic competition,” researchers from Connecticut and Oregon looked at 5,815 adults age 65 and older in the United States. Using Medicare claims and in-person interviews, the study authors identified 14 of the most common chronic conditions treated with at least one medicine, along with medication classes recommended to treat these conditions and used by at least 2% of the study participants.

Of the 27 drug classes used to treat the most common chronic conditions, 15 recommended for use in one condition can have negative effects on another. Competing conditions include high blood pressure and diabetes; coronary artery disease and diabetes; high blood pressure and osteoarthritis; high blood pressure and chronic obstructive pulmonary disease (COPD); and high blood pressure and depression. Among the study participants, 22.6% were taking at least one medicine known to adversely impact another of their conditions. For example, 16.2% of the study subjects with both hypertension and COPD were using a nonselective beta-blocker — a type of drug that can cause airway resistance, worsening COPD — to control their blood pressure.

“More than 9 million older adults in the US are being prescribed medications that may be causing them more harm than benefit,” said study coauthor Jonathan Lorgunpai.

Competition between medicines is not the only concern, according to the study. Using multiple drugs can also increase the prevalence of falls, delirium, dizziness, fatigue, and loss of appetite.

“Drugs tend to focus on one disease at a time, and most physicians treat patients the same way. As a result, right now we’re probably treating too many conditions with too many medications. There may be times it’s best to just focus on the most serious health problem, rather than use a drug to treat a different condition that could make the more serious health problem even worse,” noted study author David S. H. Lee, PharmD, PhD.

Further study and more awareness of the issue are needed, the researchers suggest. Many doctors are aware of these issues, but few guidelines exist informing health-care providers how to identify other options. It may be possible, the authors continued, to make better judgments about which health condition takes treatment priority or to identify options for treating both conditions that don’t conflict with one another.

For more information, read the article “One in five older Americans take medications that work against each other” or see the study in the journal PLoS ONE. And to learn about drugs that can worsen diabetes control, read this article by clinical pharmacologist Mark T. Marino.


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