Reducing the Proportion of Older Adults Who Take Inappropriate Medications: Key Opportunities to Achieve Healthy People 2030 Goals

Medication harms take a devastating toll on older adults, and everyone involved in the care of older adults can help reduce this public health risk. That is why reducing the proportion of older adults who use [are prescribed] potentially inappropriate medications is a Healthy People 2030 objective and one of the key principles of age-friendly care that The John A. Hartford Foundation (JAHF) passionately promotes.??

The U.S. Department of Health and Human Services’ Office of Disease Prevention and Health Promotion (ODPHP) leads the Healthy People 2030 Initiative, which establishes clear, long-term public health objectives that span over a decade. The initiative provides tools to advance national progress towards these goals. As a Healthy People 2030 Champion, JAHF is promoting these public health goals by empowering older adults and supporting their caregivers.??

In my prior articles from this year, I have discussed the ways in which our organization is helping achieve Healthy People 2030 objectives by encouraging older adults to engage in health discussions with family and friends, improving access to comprehensive dementia care, and decreasing fall-related deaths. Reducing medication harm is equally important.?

Why Medications Matter???

Individuals aged 65 and above are at high risk of adverse effects of certain medications. According to recent data from the CDC, adverse drug events result in over 600,000 emergency room visits by older adults each year. The Beers Criteria, developed by the American Geriatrics Society, lists over fifty potentially inappropriate medications that pose risks for older people. The most prescribed medications that fall under this criterion are benzodiazepines, anticholinergics, opioids, antipsychotics, and non-steroidal anti-inflammatory drugs. As we age, our bodies take an extended amount of time to break down medications, causing them to stay in our systems longer. Side effects of medications can also be much more problematic for older adults than younger people, affecting the ability to perform everyday activities.??

Older adults take more medication than any other age group, often for multiple existing conditions. A report conducted by Age Wave and JAHF of over 2,500 older adults found that the average older adult takes 4 daily medications, with over 15% taking 8 or more. Medications that treat one condition may worsen another. The threat of drug-drug interactions also increases, which can affect how well the medications work, compromise safety and increase the likelihood of serious side effects.??

Given these circumstances, it is critical to ensure that older adults are prescribed appropriate and safe medications.? Data from the Agency for Healthcare Research Quality (AHRQ) show that 15.9% of older adults use inappropriate medication. The Healthy People 2030 objective aims to reduce that percentage to 11% over the next ten years.????

How Age-Friendly Initiatives Decrease the Use of Inappropriate Medications by Older Adults???

Age-Friendly Health Systems?

Age-Friendly Health Systems (AFHS) is a movement championed by JAHF and the Institute for Healthcare Improvement (IHI), in partnership with the American Hospital Association (AHA), The Catholic Health Association of the United States and several other collaborators that promotes the delivery of evidence-based and patient-centered care practices to older adults through the 4Ms Framework: what Matters, Medication, Mentation, and Mobility. The crucial first step is initiating a conversation with older adults about what matters most to them based on their health goals, and their priorities.??

Evaluating the medications that older adults are prescribed is paramount. Medications are assessed as to their impact on the other Ms of age-friendly care. Medication interactions and/or a potentially inappropriate medication that causes confusion, dizziness, and drowsiness, for example, can affect a person's mentation and ability to think clearly. Medication use can make safe mobility a problem and can increase the risk of falling. Together, these issues will likely prevent the older person from doing what matters to them. The prescriber must assess the “trade-offs” of medication management and the goals and preference of the older adult.? This decision is not always easy, and approaches like Patient Priorities Care can help guide both clinicians and patients.?

My Health Checklist?

IHI has released a My Health Checklist for older adults, complete with a medication section to assess their current medications before meeting with a health care provider. This checklist was designed to evaluate whether the medications older adults are taking are helping them reach their individual goals, the problems they are experiencing due to medication, and what should be discussed with prescribers. The checklist is a valuable tool that empowers older adults to take an active role in their health care, ensuring that their medications align with their health goals and needs.???

Making certain that older adults, their family caregivers and providers can navigate the complexities of managing medications is fundamental in age-friendly care. In the same JAHF/Age Wave report, only half of the respondents said that their primary care providers coordinate with their other providers regarding their medication plans. When multiple clinicians are prescribing medications without communicating, it can become difficult for older adults to manage the number of prescriptions they have been given. Age-friendly care advocates de-prescribing medications that are more hazardous than helpful. This is why healthcare providers of older adults must review and discuss all the medications older adults take and align medication prescriptions with what matters, mentation and mobility.??

Leveraging Pharmacists as Age-Friendly 4Ms Champions?

The American Society of Consultant Pharmacists (ASCP) is a nonprofit association of pharmacists and pharmacies that manage the medications of older people in nursing homes and community settings. The organization’s mission is to provide Senior Care Pharmacists with education, resources and innovative opportunities to promote healthy aging and to champion the AFHS 4Ms Framework. ASCP partners with the Peter Lamy Center on Drug Therapy and Aging at the University of Maryland School of Pharmacy and JAHF to advocate for pharmacy-based age-friendly care.???

ASCP offers a home-study course that provides a comprehensive framework for Senior Care Pharmacists to improve the care of older adults within the AFHS initiative. Participants learn how to better understand the complex interrelationships between disease states, nutrition, medications and other variables, helping them provide more patient-centered care to older adults. Upon completing the training, there is the opportunity to receive an Age-Friendly badge. This course is free, and participants can receive BCGP/CPE credits.??

ACSP has formed a national advisory council, created a medication optimization learning collaborative across eight regions, and will train 2,500 pharmacists and 950 long-term care pharmacies, with at least 250 pharmacies earning ASCP Age-Friendly national recognition.??

Opportunities to Engage in Age-Friendly Initiatives and Advance Healthy People 2030 Objectives??

There are over 4,700 healthcare sites nationwide that are recognized as Age-Friendly Health Systems Participants, and all are working to reduce medication harm. Seven-month Action Communities are virtual learning opportunities to evaluate and enhance the adoption of the 4Ms with a network of peers across different health systems. IHI invites healthcare teams to register for the next Action Community in March 2025. Similarly, the VA is calling on health systems to join their 2025 Action Community starting in January as part of their effort to become the nation's most extensive Age-Friendly Health System. The Healthcare Association of New York State (HANYS) also encourages health system teams to participate in the 2025 New York State AFHS Action Community, which will begin in January.???

All of these opportunities are free of cost, thanks to grants from JAHF and other funders.??

Join Us??

JAHF is committed to supporting Healthy People 2030 and encourages other organizations to join us in lowering the percentage of older adults taking inappropriate medications. We urge you to encourage health systems in your communities to join the AFHS movement through an Action Community or in other ways.??

We also encourage you to discover other Healthy People 2030 objectives that align with your organization's mission and services. You can participate in our JAHF grant initiatives, take advantage of our resources, and share how you're working towards achieving the Healthy People 2030 goals. Together, we can promote a healthier decade of aging for everyone.?

?Special thanks to Alyssa Gilbert for co-authoring this article.

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