Thanks to some medical advances, we can cure diseases and we are learning more and more about how to also prevent diseases. But today’s medical care also has a big downside. Inaccurate and inadequate drug treatments in the Swedish health care costs society billions of money each year and creates a huge unnecessary suffering.
More than one third of medical patients in the emergency room are there because of their drugs, research suggests. Problems caused by drugs has become the most common cause of being hospitalized in Sweden.
Despite this, awareness is lacking about the problem in the country’s emergency care. Research shows that only a small number of hospitals know the proportion of patients who ended up there because of their medicines. Follow-up and evaluation of the medications that are given is often lacking throughout the entire continuum of care.
Bad drug control
Consultant Jessica Fryckstedt is doing research and examine how often patients’ medications cause that they end up in hospital.
– For example, here we have a patient who has fallen, it is unclear why they have not asked about the patient’s medications. And so we go in and check and we see that she is on a lot of antihypertensive medications. And then, of course, it is possible that these medicines have had too great effect, it may be the reason behind that she has fallen.
-Here we have another patient who is on a lot of drugs, and is a little older and have multiple diseases. Then it usually … I know from experience that then they often take drugs that do not fit together, or drugs that cause side effects. Then you have to go in and think actively on drug-related problems to find them.
Johan Lepitsu is 89 years old and had severe dizziness in the morning after he took his cocktail of different drugs and had to go by ambulance. When Jessica controls his double drug list it is not much that is correct.
– He clearly illustrates the confusion that patients feel about their medication list and the medicines they take. You heard himself that he had received various medications prescribed by different doctors, he himself took drugs that were not on the list, and he did not take some drugs that were on the list. It means that we really have no idea what drugs the patient is taking.
So what to do with a patient like Johan? Dizziness is one of the most common symptoms of drug reaction and there is a total confusion about his medication.
– A patient like this would surely do well to be admitted to a ward, in which they are often very good at looking through the drug list. The doctors in geriatrics has a special interest in drugs. The worst is if he is sent home and that no one perceives the problem.
Drug related problems underestimated
In two different studies, Jessica followed up a total of 1000 non-surgical patients who came to the adult emergency room and then was admitted to a ward. She found that in more than one third of the cases, the drugs were the underlying cause of the patient’s problem.
– I think the first there thing that is needed is to increase awareness of drug-related problems. It is very important that we, both doctors and officials and politicians in health care settings, understand the extent of this problem.
Despite the magnitude of the problem, few hospitals have knowledge about it.
Forty hospitals in Sweden were contacted and only four of them had bothered to find out how many of their admissions were caused by drugs.
– Yes, but it is fairly symptomatic of this situation, Jessica Fryckstedt says. We do not know the problem, we do not think about it, we are not sufficiently aware of that drug-related problems is a huge concern. It testifies just that you do not know it, that you will not find that the drug-related problems will be continued, and the patient will have to pay in the form of suffering and time in hospital and medication errors, and so on.
Worse than cancer
Drug-related problems is a generic name for a variety of concerns.
Foremost it is the side effects. It may often be that the dose of a substance becomes too high and important organs as the liver and the kidneys start to fail. It is also common that a person has two or more drugs that do not fit together.
The two largest pharmaceutical groups in this context are very common. It’s cardiovascular medications and drugs that affect the brain, as analgesics, anticonvulsants and sedatives.
At Huddinge hospital, professor Ulf Bergman works. He has been researching this since the 70s and, according to his studies, the percentage of patients admitted due to drug-related problems has doubled since then. He estimates that today it is the most common cause of hospitalization.
– There is no single disease which causes so great hospitalization level, so to speak.
Not heart attacks? Not Cancer?
– No, they’re … in their individual departments they stand for many of the cases, but not in the entire hospital. This is one of the largest cost items we have. It costs huge amounts. If we look at a drug bill of 35 billion, then it is probably half of that cost that comes because of various problems related to drugs.
According to the studies done in Sweden the problem increases with the patients age.
Research shows that between 5 and 10 percent of all admissions to Swedish hospitals is because of drugs.
But when looking at medical, i.e. non-surgical wards, where patients are a little older, then it is about one third.
And when it comes to our oldest patients in the geriatric clinics, there the figure is around 50 percent, i.e. half. Several of the doctors and scientists think that the drug-related problems must be seen as a symptom of a dysfunctional health care for older persons.
Alzheimer’s worsened because of drugs
Johannes Wallin lives in Umeå. About ten years ago Johannes’ wife Ulla started get a little forgetful and confused, and it was then discovered that she has Alzheimer’s disease. But the disease progressed slowly and they could continue to have a good life together.
Life changed radically after that Ulla for a little more than three years ago began with two very common drugs: a disease-modifying drug that could halt the progress of the disease and an antidepressant, so-called happy pills, which would make life a little easier. Both of these drugs have the side effect of lowering the seizure threshold which, incidentally, is already reduced in people with dementia.
– When we were out driving a car, for example, she began to fumble at her feet and picked things in the air that was not there. And that got worse with time. After a time she fell, and tumbled to the ground.
She then got diagnosed with epilepsy, and consequently got a new drug. After that her dementia suddenly became ten times worse.
– Yes, she was of course extremely absent. Very tired. Without life. She was … when she was healthy, she was happy and lively and but she disappeared entirely. She became like a package.
Now she cannot stay at home any longer. She was sent to Tegs center for the elderly. Chief Yngve Gustafson remembers his first meeting with Ulla.
– And then she was bedridden. She could not talk, she was hallucinating, she could not feed herself. She could do almost nothing. She was in a very, very bad condition. And since then … the basic principle for old, frail people and especially with very fast progression of dementia – then you always have to suspect that it comes from side-effects from drugs. And then when we also see that the patient is on medications that cause and aggravate epilepsy, that is basically contraindicated, that means unsuitable to use when you have epilepsy, especially a kind of epilepsy it has been difficult to get control of, where you got to raise the dosage of the epilepsy medicine time and again to keep away the cramps.
– What we did when she moved in here was that we took away those two medications, and then we could also remove the epilepsy medication. And just one week after she could … she got up out of her bed and began to talk and eat and walk by herself.
– Yes, it was noticed pretty soon a reversal of these problems.
But she will never be fully recovered. The severe epileptic seizures and severe side effects of the drugs have worsened her illness permanently. Yngve Gustafson says that the errors that were committed here are typical of how the health care is organized in these days.
Since this happened, Johannes had a stroke. Ulla will never be able to move back home. Instead, he visits her as often as he can.
– I need her now, we have lived together all our lives and know each other inside out and … but I’m glad I can maybe help her to go out and maybe watch something and hear some music and … we walk along the river and get to see the water and I think she likes it. It’s the only thing I live for now, something else I do not have to live for.
Ulla lies in her wheelchair and listens to jazz when Johannes comes on his daily visit to Tegs center for the elderly. She is dressed in a maroon sweater and her gray-black hair is newly combed. Her eyes are clear but still absent. Her voice is weak with long gasps.
Elderly people more sensitive
– It is so easy to believe when you see old people, they are wrinkled, they are gray-haired, that they are equal in some way. But it is just the opposite. When you get old, people become more and more sensitive to drugs and it is very different from person to person. There’s no group of people where you so easily can cause problems with the wrong treatment.
Over the past 20 years, the medical prescription to people over 75 has doubled. But hardly any drug is tested on humans in that patient group. How they affect, decrepit, multi-ill elderly, is not known. Yngve Gustafson is a professor of geriatrics at Norrland University Hospital and he says that he sees drug treatment of older people as a risky experiment.
He estimates that as much as one third of the drugs that old people use they have gotten because of side effects from other drugs. The reason for it is just like in the case of Ulla, to treat symptoms without investigating the reason behind.
One thing leads to another
– These patients, these old, they go from one doctor to another doctor. They are looking for different symptoms and they get pills against these different symptoms. I had a woman here some time ago that went to the district doctor because she was out of breath and she also had swollen legs. For that she got diuretic medication. Because of that medicine she got difficulties to hold her urine so she became incontinent and had to start with the diapers.
Then after half a year or a year she got gout, joint pain, because it is also a very common side effect of diuretic medication. She also became constipated so she had to take laxatives. And against the gout … they did not understand that it was due to the medication, but then she was put on painkillers. And of the painkillers she got ulcers and so she got medicine for her stomach ulcer. And then it went on in this way, and then she had severe side-effects that ultimately led to the fact that she died. In her case, it began with incorrectly inserted drugs. After more than a year, she had ten drugs all of which were against the side effects of earlier given drugs. And these kinds of examples are encountered quite often.
Erling Persson and his wife Gunilla Sponton live in Burträsk in the south of Skellefteå.
Erling has a successful wrestling career behind him and led an exercise group for retirees, until he recently began to get worse hip pain, and the pain made him more and more crippled.
– If I would, for example, go out of the car and turn the leg it was as if you stabbed a knife in the hip. When you step out of bed in the morning it was difficult if you were about to dress with socks, for example. I needed help from Gunilla.
Possibility to recover from some side-effects
– I really thought that my hip was damaged. And then I got a sore toe also and could not even press the clutch in the car. I had to use my heal when it was at its worst. And I could not accept it because I’m seventy years next year and I’m pretty fresh, I mean I am physically fit. And I thought that sort of thing cannot happen to me.
What Erling and his wife had not a thought of was that all the symptoms could be a side effect of his blood pressure medication, a certain type that over half a million Swedes regularly eat.
But after a year ruined by pain and gout, and in the belief that his hip was damaged, Erling got a tip that he should talk to Yngve Gustafson, who suggested that he would try to change medication.
– When I changed the medicine and took away the diuretic then … after a week or so, I had no more problems.
– It is clear that you feel disappointed when you get to know that it was a drug that caused it, angry because it … it’s unnecessary. And it should probably be followed up more, what they give to people and not just prescribe and let it go. There should be controls what is happening. It’s not followed up anything! That’s the worst.
How did it then go for 89-year-old Johan Lepitsu, who received severe dizziness after taking his medicine in the morning, and that came in to the emergency room at the Karolinska Hospital in Solna? Was he admitted in a geriatric department as medical doctor Jessica Fryckstedt recommended, where they would investigate his symptoms and go through his chaotic drug list?
No, he was not admitted even if he himself wanted to. This is unfortunately the way it often becomes, that there is no room in the hospital, there is no place in the geriatric care, the patient is not sick enough to require care at the emergency hospital, and then you have to go home. And so the problem remains unsolved.
Much more preventative health care is needed in today’s society. If we would stick to the original diet given in the Bible to us humans, we would not have to run so often to the doctor. We could also learn more about natural remedies that we could use ourselves if we get sick. Even if we also have to be careful with how we use these natural remedies, they don’t come with the same side-effects that many synthetic man-made pills do.
This article is partly a summary and translation from the Swedish radio editorial:
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