Study: Many Elderly Getting Wrong Drugs

'Potentially inappropriate medications' for 1 in 5

TUESDAY, Dec. 11, 2001 (HealthDayNews) -- A depressingly high percentage of older Americans are being prescribed medications that they would be better off without, a federal survey finds.

"In 1996, 21.3 percent of community-dwelling elderly patients in the United States received at least one of 33 potentially inappropriate medications," say experts at the Agency for Healthcare Research and Quality, whose report appears in the Dec. 12 issue of the Journal of the American Medical Association.

That number comes from analysis of the 1996 Medicaid Expenditure Panel Survey, which looks at overall health care use, says Dr. Arlene S. Bierman, a senior research physician with the agency's Center for Quality Improvement and Patient Safety. The analysis was done by a panel of experts who reached a consensus on the often-controversial issue of which drugs older people shouldn't be taking.

"There is a controversy about the list, so we convened this expert panel," Bierman says. "They listed drugs that should always be avoided, some that should rarely be used, and some that are often misused."

About 2.6 percent of the 2,455 older people surveyed were taking at least one of the 11 never-use medications, the study finds. These drugs include barbiturates, the tranquilizer flurazepam and the narcotic painkiller meperidine.

More than 9 percent were taking at least one of the eight drugs ranked as rarely appropriate, including the tranquilizers diazepam and chlordiazepoxide and the painkiller propoxyphene.

And 13.3 percent were taking medications that might be appropriate but are often misused, such as the antidepressant amitriptyline and the antihistamines promethazine and hydroxyzine.

There is room for argument about some of the drugs in the latter two categories, Bierman acknowledges, which is why the expert panel was called on to draw up the lists. So one reason why doctors may prescribe some of the drugs is "lack of evidence and consensus on what constitutes appropriate drug use," she says.

"We don't have enough evidence in many cases because older people are often excluded from clinical trials," Bierman says.

But doctors often aren't aware enough of the different effects of a drug in younger and older patients, she adds. "Many physicians don't have enough education in the principles of geriatric care. As people age, they metabolize drugs differently," she says.

That is a critical point, says Dr. David Nash, professor of health policy at Jefferson Medical College, and lead author of a report that reached the same conclusions last year.

"The metabolism of the elderly is different from that of middle-aged patients," Nash says. "They don't clear medications from the kidney and liver as younger people do, and the interactions between medications are different than in younger patients."

It's necessary for doctors to go slowly in prescribing drugs to older patients, to see how well they react, Nash says. It's also necessary to give doctors access to a wide range of drugs for their older patients, he says, which is difficult in many cases because health plans limit the drugs that can be prescribed.

"You must have flexibility in using different products in the same class," Nash says. "Restrictive formularies are bad."

The issue of inappropriate drugs for older patients is becoming more important, he adds.

"As the population ages, this becomes a critical national issue," Nash says. "This study supports the need for better medical education."

What To Do

"Consumers need to be aware of the potential benefits and harms of any drugs they use," Bierman says. "They must work with their doctors and feel free to discuss the medications they are taking."

For information about drugs and the elderly, consult the Food and Drug Administration. For more information in general about the elderly, try the National Institute on Aging.

SOURCES: Interviews with Arlene S. Bierman, M.D., senior research physician, Agency for Healthcare Research and Quality, Rockville, Md.; David Nash, M.D., professor of health policy, Jefferson Medical College, Philadelphia; Dec. 12, 2001 Journal of the American Medical Association
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