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Dangerous Drugs Provided to 21 Percent of Elderly
Aug. 10, 2004 – A large study has found that 21
percent of the elderly were given drug prescriptions for medications
identified as “inappropriate” by the Beers list, which identifies drugs
to be avoided for the elderly.
Prescribing of inappropriate medications for
elderly patients appears relatively common, according to an article in
the August 9/23 issue of The Archives of Internal Medicine, one
of the JAMA/Archives journals.
Persons 65 years or older make up less than 15
percent of the population, but make up nearly one-third of prescription
drug users. Elderly persons are also more likely to take several drugs
concurrently, the article states.
Lesley H. Curtis, Ph.D., of Duke University Medical
Center, Durham, N.C., and colleagues investigated the extent of
potentially inappropriate medication prescribing for elderly patients
not in the hospital.
Inappropriate medications were identified according
to criteria set by physicians and pharmacologists, as defined by a list
known as the Beers revised list of drugs – a list of drugs to be avoided
in the elderly.
(More about Beers Criteria -
Click Here)
The researchers studied the outpatient claims
database of a large national pharmaceutical benefit company. The
database included 765,423 patients aged 65 or older who filled one or
more prescription drug claims during 1999.
The researchers found that 162,370 patients (21
percent) filled a prescription for one or more drugs of concern
(medications that should be avoided in elderly patients or which are
inappropriate for use in elderly patients). Amitriptyline and doxepin
(drugs used for treatment of depression) accounted for 23 percent of
claims for Beers list drugs, and 51 percent of those claims were for
drugs with potentially harmful effects. More than 15 percent of patients
filled prescriptions for two drugs of concern, and 4 percent filled
prescriptions for three or more drugs of concern within the same year.
“The common use of potentially inappropriate drugs
should serve as a reminder to monitor their use closely,” the authors
write. “Pharmaceutical claims databases can be important tools for
accomplishing this task, though clinical and laboratory data are needed
to improve the sensitivity and specificity of patient-specific alerts.”
Editorial: The Time To Act Is Now
In an accompanying editorial, Knight Steel, M.D.,
of Hackensack University Medical Center, New Jersey, writes that the
article “bespeaks a significant failure in the American health care
system. Using a 1999 claims database of over three quarters of a million
elderly subjects from a national pharmaceutical benefit manager, they
report that 21 percent of this population filled a prescription for a
drug deemed to be potentially inappropriate for this age group by an
expert panel. Although the drugs included on such a list may vary
depending on the views of the members of the panel, if even half that
number of elderly subjects are taking potentially inappropriate
medications, one in ten of all older persons is receiving a drug that is
potentially not appropriate.”
Dr. Steel states that whatever the reason for the
high rates of inappropriate prescribing to elderly patients, “the time
has come to decrease the likelihood of inappropriate prescribing.”
“One way to begin is to include pharmacists in the
process of prescription writing in a more meaningful way. Since they
usually have information about patients’ age, pharmacists could be
required to question the use of certain drugs or dosages in the
elderly.”
Dr. Steel suggests, “Perhaps the easiest and likely
the best way of lowering the number of inappropriate prescriptions would
be to design a computer program available to all pharmacists that
identified all inappropriate prescriptions.”
(The complete report can be found by
Clicking Here.)
This is the magazine’s Website -
http://archinternmed.com)
Editor’s Note: This work was supported by a Centers
for Education and Research on Therapeutics cooperative agreement between
the Agency for Healthcare Research and Quality, Rockville, Md., and the
University of Arizona Health Sciences Center, Tuscon. |
