• How many of the elderly take supplements? Also, why that might be really bad.

    There are a few topics I cover here or at Healthcare Triage that just won’t seem to go away. Vaccines and autism. Diet and exercise. Survival rates. But the one that trumps them all is supplements. Americans seem obsessed with them.

    The one group I thought might not be overtaken by this craze was the elderly. Boy, was I wrong. “Changes in Prescription and Over-the-Counter Medication and Dietary Supplement Use Among Older Adults in the United States, 2005 vs 2011“:

    Importance  Prescription and over-the-counter medicines and dietary supplements are commonly used, alone and together, among older adults. However, the effect of recent regulatory and market forces on these patterns is not known.

    Objectives  To characterize changes in the prevalence of medication use, including concurrent use of prescription and over-the-counter medications and dietary supplements, and to quantify the frequency and types of potential major drug-drug interactions.

    Design, Setting, and Participants  Descriptive analyses of a longitudinal, nationally representative sample of community-dwelling older adults 62 to 85 years old. In-home interviews with direct medication inspection were conducted in 2005-2006 and again in 2010-2011. The dates of the analysis were March to November 2015. We defined medication use as the use of at least 1 prescription or over-the-counter medication or dietary supplement at least daily or weekly and defined concurrent use as the regular use of at least 2 medications. We used Micromedex to identify potential major drug-drug interactions.

    Main Outcomes and Measures  Population estimates of the prevalence of medication use (in aggregate and by therapeutic class), concurrent use, and major drug-drug interactions.

    Researchers wanted to look at how the prevalence of dietary supplements and over-the-counter medication use changed in the elderly from 2005 to 2011. They were especially concerned about how these products might potentially be the cause of major drug-drug interactions. They conducted a longitudinal, nationally representative cohort study of community-dwelling adults age 62-85. They interviewed them and directly examined their medications in 2005-2006, and then again in 2010-2011.

    Before I even get into the results, we need to acknowledge some facts. Supplements are HUGE business in the United States. In 2015, we spent $21 billion on vitamins and herbal supplements. What makes this baffling is that supplements aren’t heavily regulated in this country. That means that it’s entirely possible that what you think you’re taking bears no resemblance to what you’re actually swallowing. Don’t take my word for it; investigations have confirmed this is not an unlikely thing to happen.

    And while doctors and EMRs regularly screen for prescription medications, we often miss over-the-counter medications, let alone supplements. Many don’t consider them when they talk about “medications” in the clinic or hospital.

    In this study, more than 2000 participants, average age 71 years or so, were interviewed in both time periods. In 2005, 84% used at least one prescription medication, and in 2011, that increased to 88%. The concurrent use of at least five prescription medications increased from 31% to 36%. Over-the-counter medications decreased, from 44% to 38%.

    But the use of supplements increased, from 52% to 64%.

    The potential for major drug-drug interactions increased significantly as well. It was about 8% in 2005, increasing to more than 15% in 2011. Most of these new potential problems were due to interactions between medications patients were prescribed and supplements they were taking.

    It’s bad enough that so many Americans are taking supplements which (1) can be expensive, (2) often provide no proven benefit, and (3) may not even be full of what the bottle says they are. What’s worse is that many of these supplements may also be increasing the potential for adverse outcomes due to other medications that they’re already taking. Physicians, and the health care system, need to be aware that even among the elderly, huge numbers of people are taking these substances, which might not only be doing them no good, but also be doing them harm.

    @aaronecarroll

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