1 in 12 drugs inappropriately prescribed to elderly

Healthfacts, March, 2004

Nearly 8% of the ambulatory medical care visits made by elderly people resulted in at least one inappropriate drug prescription, according to a survey reported in Archives of Internal Medicine (2/9/04). Urban women and white people made the majority of visits to physician offices and hospital outpatient departments.

Margie Rauch Goulding, PhD, of the U.S. Centers for Disease Control and Prevention, conducted the survey, which identified pain relievers and central nervous system drugs as making up the largest share of the inappropriately prescribed medicines. The two pain relievers are pentazocine (brand name: Talwin) and propoxyphene. The latter is sold under the brand names of Darvon, Darvon-N and prescribed in combination with acetaminophen (Tylenol) as Darvocet-N and Wygesic. Or sold as Darvon Compound, which combines propoxyphene, aspirin and caffeine. Propoxyphene is a narcotic that should be avoided by everyone, not just elderly people. Studies conducted over 20 years ago showed that it is no more effective as a pain reliever than aspirin or a placebo, even in people with cancer or postoperative pain. Furthermore, propoxyphene has the potential for addiction and overdose.

The inappropriately prescribed central nervous system drugs include barbiturates, tranquilizers, and antidepressants. Often, drugs in this category are prescribed to elderly people for insomnia, or in the case of antidepressants, for pain. The problem tranquilizers are flurazepam (Dalmane) chlordiazepoxide (Librium), meprobamate (Equanil, Miltown) and diazepam (Valium and others). The antidepressants that caused problems were from an older drug class amitriptyline (Elavil, Amitid) and doxepin (Sustiva).

Dr. Goulding found that the odds of having an inappropriate drug prescribed were double for women and high for any visit in which multiple drugs were prescribed. To determine what is an inappropriate drug for elderly people, Dr. Goulding drew on criteria developed by panels of experts in geriatric medicine. Inappropriate was defined as a drug that panel members agreed would have a risk of adverse effects that was larger than the potential benefits.