Dec. 29, 2008 – It has long been well established
that senior citizens are the leading pill poppers in the U.S. A new
study, however, finds the dangers for adverse drug reactions is
increasing as the use of prescription and over-the-counter medications,
along with dietary supplements, is increasing rapidly among the oldest
age groups.
A study in the December 24/31 issue of Journal of
the American Medical Association (JAMA) suggests that nearly half of
older adults in the U.S. use prescription and over-the-counter
medications together, and that about 4 percent of older adults are
potentially at risk of an adverse drug reaction because of an
interaction between medications. The researchers also found that nearly
30 percent use at least 5 prescription medications.
Rates of prescription medication use have increased
considerably over the last several decades, as have the rates of use of
over-the-counter medications and dietary supplements.
Several factors have likely contributed to this
increase in the rate of [the use of five or more medications] among
older adults over the last decade, the researchers report.
These include:
● intensification of therapy for common chronic medical conditions,
such as, diabetes, cardiovascular disease;
● increased access to medications because of policy changes, primarily
the establishment of Medicare Part D and assistance programs, and
● growth of the generic drug market.
"One recent report estimated that U.S. adults older
than 65 years make more than 175,000 emergency department visits
annually for adverse drug events; commonly prescribed medications
accounted for one-third of these events," the researchers note.
Older adults are the largest per capita consumers
of prescription medications and the most at risk for medication-related
adverse events, according to previous research.
"Despite concerns about drug safety and new federal
policies to improve older adults' access to medications, current
information on their concurrent (regular use of at least 2 medications)
use of prescription medications, over-the-counter medications, and
dietary supplements is limited," the authors write.
Dima M. Qato, Pharm.D., M.P.H., of the University
of Chicago, and colleagues analyzed data from a survey to estimate the
prevalence and patterns of medication use (including concurrent use) and
major drug-drug interactions among older adults, age 57 through 85
years.
The survey included 3,005 community-residing
individuals, who were drawn from a cross-sectional, nationally
representative sample of the United States. In-home interviews,
including medication logs, were administered between June 2005 and March
2006.
Medication use was defined as prescription,
over-the-counter, and dietary supplements used "on a regular schedule,
like every day or every week." The survey response rate was about 75
percent.
Study Highlights
● During 2005 to 2006, 91 percent of older
adults, corresponding to 50.5 million adults age 57 to 85 years,
regularly used at least 1 medication.
● Among all medication types, prescription
medication use was the most prevalent, used by 81 percent, or an
estimated 44.9 million older adults.
● The prevalence of prescription medication use
was highest among the oldest age group, age 75 to 85 years.
● Nearly one-half of older adults regularly used
at least 1 over-the-counter medication or dietary supplement.
● Women were more likely to use prescription
medications and dietary supplements than men, whereas use of over-the
counter medications was similar among women and men.
● More than half of older adults used 5 or more
prescription medications, over-the-counter medications or dietary
supplements.
Prescription Medications
● 29 percent of all respondents used more than 5
prescription medications. The prevalence of the use of 5 or more
prescription medications increased steadily with age for both men and
women and was overall significantly higher among women.
● Overall, 68 percent of older adults using
prescription medications were concurrently using over-the-counter
medications, dietary supplements, or both.
● The researchers also found that 1 in 25 (4
percent) older adults (approximately 2.2 million) were at risk for a
major potential drug-drug interaction.
● The rate of any major medication interaction
increased with age for both men and women but was higher among men
compared with women across all age groups.
● More than half of these major interactions
involved the use of nonprescription therapies. In addition, nearly half
involved the use of anticoagulants like warfarin) or antiplatelet agents
like aspirin).
"Our findings suggest that concurrent use of
prescription and nonprescription medications in older adults remains a
public health problem and could be an important focal point for further
improvements in drug safety for seniors."
"Medications are a critical modality for
prolongation of life and improved quality of life for many older adults.
By establishing patterns of prescription and nonprescription medication
use among older adults, these data may help support efforts to increase
the safety and quality of pharmacotherapy for older adults," the authors
conclude.
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