Many Older Patients on Risky Drugs

Study finds 20% get medicines their bodies can't handle

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HealthDay Reporter

MONDAY, Aug. 9, 2004 (HealthDayNews) -- At least 20 percent of elderly Americans are being prescribed drugs that could possibly harm their aging bodies, new research claims.

"There is a list of medications, called the Beers list, that may not be appropriate for people over 65," said senior researcher Dr. Kevin Schulman, a professor of internal medicine at Duke University. "The question is, how often are those medications used in clinical practice?"

"We found that one in five patients over 65 who receive a prescription receive a prescription for one of these medications. In fact, over 15 percent of these patients receive prescriptions for two or more of these medications," Schulman said.

Worse yet, of the 765,423 people included in the study, 4 percent were given prescriptions for three or more risky drugs, according to the report in the Aug. 9 issue of the Archives of Internal Medicine.

The impact of the findings could be sizable: While only 15 percent of the U.S. population is considered elderly, this group consumes one-third of all medications prescribed each year.

The scope of the problem was much larger than the research team expected, Schulman added. The most common cases involved antidepressants and muscle relaxants, which can tax aging kidneys to the breaking point.

In their study, Schulman's team collected data on prescriptions filled for all patients over 65 who filed claims in 1999 with AdvancePCS, a part of Caremark Rx Inc. Patients hailed from all 50 states and two U.S. territories.

Psychotropic drugs on the Beers list were the most commonly prescribed to this older age group, making up 41 percent of the prescriptions. Prescriptions for the antidepressants amitriptyline and doxepin (AdapinR, SinequanR, ZonalonR) and the anti-anxiety drug diazepam (ValiumR) made up almost a quarter of the prescriptions. Second most common were prescriptions for inappropriate muscle relaxants such as carisoprodol, chlorzoxazone (Paraflex) and cyclobenzaprine (Flexeril).

Most of the time, there is an alternative to these medications, so physicians can use something that's safer, Schulman noted.

"We have to pay a lot more attention to the potential toxicity of the medications older people are taking," he said.

"People over 65 who are in good health don't realize that their kidneys don't function as well and they don't metabolize drugs as well as they did when they were younger," which is one reason some medications can be harmful, Schulman explained.

"We are not always aware that there are problems with these medications as we get older," he added. "When you get a prescription, make sure you ask your physician if it is safe in those over 65. Is the drug metabolized by the kidneys? Are you on the right dose, given your age?"

Another expert agrees that action must be taken to safeguard elderly patients.

"There is a fair number of inappropriately prescribed drugs for elderly Americans, and it's time we did something about it," said Dr. Knight Steel, chief of geriatrics at Hackensack University Medical Center.

Steel, who wrote an accompanying editorial in the journal, added, "We really should have a system in place that limits the prescription of inappropriate drugs."

Steel thinks the system could be improved if pharmacists were more involved in the prescribing of drugs, if there were computerized systems that worked better, and if doctors were better-trained.

Steel believes the problem of prescribing the wrong drugs is serious but unrecognized. If that many schools had asbestos falling from the ceiling and that many operating rooms were contaminated, "we would be up in arms about it," he said.

"We need a better system for prescribing drugs in a way that maximizes the benefits and minimizes the risks," Steel said.

More information

The National Library of Medicine can tell you about prescription drugs.

SOURCES: Kevin Schulman, M.D., professor of internal medicine, Duke University, Durham, N.C.; Knight Steel, M.D., chief of geriatrics, Hackensack University Medical Center and professor of geriatrics, New Jersey Medical School, Hackensack, N.J.; Aug. 9, 2004, Archives of Internal Medicine

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