Almost 30 percent of prescriptions written for people over 65 in managed care plans were for medications deemed potentially inappropriate for older people, according to new research.

The researchers also found that 5 percent of the seniors were prescribed one of 11 drugs that a consensus panel of medical experts recommend older patients should "always avoid."

"Medication safety is of paramount concern in the elderly," said study author Dr. Steven Simon, an assistant professor of ambulatory care at Harvard Medical School. "Errors and potentially adverse drug events in the elderly are a public health concern because [as a group] older persons use more medications and seek more medical help than younger persons."

For the current study, published in the February issue of the Journal of the American Geriatrics Society, Simon and his colleagues gathered data from an 18-month period in 2000-2001 on more than 157,000 people over 65 enrolled in 10 HMOs across the country.

The researchers tracked 33 drugs deemed potentially inappropriate in a subset of the Beers Criteria, the recognized standard for drugs the elderly should avoid.

The list classifies drugs into three categories: "always avoid," "rarely appropriate," and "might have some indications."

The study found that 28.8 percent of people over 65 had received at least one prescription for a medication that was potentially inappropriate. Five percent were given a prescription for one of the drugs in the always-avoid category. Thirteen percent received a prescription for drugs rarely considered appropriate.

Women were more likely to receive a prescription for an inappropriate medication than men, 32.4 percent compared to 24.2 percent. This may be because women, in general, are more likely to see a doctor than men are, said Simon.

Specifically, the study showed that at least 1 percent of the seniors received the antispasmodic drugs belladonna alkaloids, hyoscyamine and dicyclomine, all three of which have been classified as always inappropriate for older patients. In addition, 7 percent received propoxyphene, an analgesic medication considered rarely appropriate for the elderly.

What the current study didn't address, according to Simon, is whether the medication prescriptions actually lead to adverse outcomes.

However, the findings from a study in last month's Archives of Internal Medicine on nursing home patients would seem to suggest that taking inappropriate medications does cause serious problems.

That study found that elderly people taking inappropriate medicines for a two-month period were 80 percent more likely to be hospitalized in the third month than those not given the drugs.

"Drug interactions are a significant concern in the elderly," said Dr. Khaled Imam, associate director of the division of geriatrics at Beaumont Hospital in Royal Oak, Mich. "This study represents a small piece of the problem."

Simon said he thinks there are three factors contributing to the continuing prescription of inappropriate medications. First, he said, may be a lack of knowledge on the physician's part. Second may be disbelief that these medications, which are often older, cheaper and commonly prescribed medications, really cause adverse reactions in the elderly. And, finally, patients may be asking for certain medications.

Both Simon and Imam said physician education is vital to combating this problem. Simon said an effective technique is to meet with physicians one-on-one or in small groups to discuss why they choose certain medications and don't choose others.

What may be even more helpful, said Imam, is electronic medical records and reliance on technology to alert physicians to potentially harmful or inappropriate medications. Imam said even the best doctors can't keep all drug interactions and side effects in their memories any more.

Elderly people and their families can help by bringing a list of all of the medications -- either prescription or over-the-counter -- and dietary supplements or herbs that are in the home to each doctor visit.

That way, said Imam, your physician can alert you to any potential problems. He said something as simple as a cold medication can cause significant side effects in the elderly.

"Patients need to tell their physicians about their medication and about any other conditions they might have. This helps the physician to prescribe the right medication that has the least side effects for that patient," Imam said.

More information

For an updated list of drugs the elderly should avoid, check out the Beers Criteria.

Reference Source 101
March 1, 2005

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