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Doctors Must Be More Aware of Medications Dangerous
to Elderly, Say Researchers
1997 Beers Criteria was revised in 2003 to list
potentially dangerous drugs for elderly
Jan. 6, 2005
Researchers who found as many as 70 percent of the doctors in their
study had prescribed a potentially inappropriate medication for elderly
patients are urging physicians to be more aware of medications that are
inappropriate for the elderly.
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Beers criteria for medications to avoid in the
elderly updated
Dec. 8, 2003 - Forty-eight medications or classes
of medications to avoid in adults age 65 or older have been identified
by a national expert panel charged with updating widely used criteria
for potentially harmful medications in older adults.
More... 12/08/03*
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.
More... 8/10/04*
> Beers Criteria Revised 2003 - Table 1
- Click
> Beers Criteria Revised 2003 -
Table 2 - Click
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Just as our bodies
physically slow down as we age, changes occur in the way that older
bodies handle pharmaceuticals, and this has motivated experts to develop
a list of drugs that may be harmful to elderly patients.
"With age, drugs tend to
build up in the body, and the distribution and elimination of drugs from
the body changes as well," says Dr. Donna M. Fick, R.N., associate
professor of nursing at Penn State. "Many drugs, like diazepam (Valium)
and other anti-anxiety drugs build up fast."
Also, doctors may not
know all the prescriptions, let alone over the counter, drugs that
elderly patients are taking. "Sometimes someone is started on a drug in
their 50s, but 20 years later, it has not been reevaluated," says Fick.
"Some drugs are fine at
55 but not OK at 75. However, sometimes doctors have tried everything
else and this drug with negative implications for the elderly is the
only one that works. It is a complicated issue that requires all health
professionals to communicate better and work together, he says."
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The researchers want to
see physicians reevaluate the drugs their elderly patients take to
determine if they are appropriate, if alternative drugs would be better
or if dosages should be adjusted. They reported their findings in a
recent issue of the American Journal of Managed Care.
Fick, working with Nancy
A. Rodriguez, Louise Short and Richard Vanden Heuvel, Blue Cross and
Blue Shield of Georgia; Jennifer L. Waller; and J. Ross Maclean, Medical
College of Georgia; and Rebecca L. Rodgers, Augusta State University,
tested a method to alert physicians to possibly inappropriate
prescriptions. Fick was at the Medical College of Georgia when this work
was done.
The researchers divided
primary care physicians in Blue Cross Blue Shield of Georgia's senior
plans between a treatment and control group and sent all of doctors a
packet of information on prescribing for the elderly. The packet
included an educational letter, the brochure, "The Challenges of
Prescribing to Seniors," and the Beers criteria list. The 1997 Beers
criteria lists established drugs that have either high or low severity
adverse effects in the elderly.
Three months later, the
treatment group received additional information including a detailed
educational brochure, a list of suggested alternative medications for
potentially inappropriate medications and a personal letter that
contained a list of all the physician's patients who were taking one or
more potentially inappropriate medications. The information came from
the prescriptions filled during the previous three months.
They also gave the
physicians a fax back form on which they could reply that they
discontinued medication, assessed patient with no change indicated,
decreased dosage, prescribed an alternative or did not prescribe the
medication in question.
Approximately 70 percent
of the doctors in the intervention group had actually prescribed a
potentially inappropriate medication and of those, 71 percent responded
with the fax back form. Of those, 78.4 percent reassessed the patient
but did not change the medications, 12.5 discontinued the medication,
1.7 percent decreased the dosage and 1.2 percent prescribed an
alternative. The drug category most likely to be discontinued was
antihistamines, followed by analgesics and muscle relaxants.
Because of changes in
the Blue Cross and Blue Shield of Georgia's physician base and an
ever-changing patient population, continuation of the study was not
possible.
The fax back method was
an inexpensive method of alerting the prescribing physicians to the
problem, but it had some problems of its own.
"We could have set the
study up to call when the physician originally prescribed a drug rather
than waiting for the reimbursements for the drugs to signal drug
prescribing, but that would have been a more expensive approach," says
Fick. "With the fax backs however, we do not really know who is
receiving them or if the physician ever actually sees them."
The researchers
concluded that while most physicians did not change their prescriptions,
the added awareness of the problem was beneficial. They believe that
"thoughtful application using the Beers criteria and other tools for
identifying potentially inappropriate medication use can enable
providers and insurers to plan interventions . . . " that would decrease
the ill effects of these drugs on the elderly and improve their care.
Blue Cross and Blue
Shield of Georgia Center for Healthcare Improvement and The Medical
College of Georgia provided the funding for the study.
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