Prescription medications can be risky for older adults

AORN Journal, Oct, 2004

Many Americans older than 65 years of age have prescriptions for medications considered potentially risky for older adults, according to an Aug 9, 2004, news release from Duke University Medical Center, Durham, NC. Findings of a study by Duke researchers stress a need for greater awareness among physicians about the risks presented by commonly prescribed medications as people age and for additional measures to monitor prescription medication use.

The researchers found that during the course of a year, one in five older US adults whose benefits were processed by one of the largest pharmaceutical benefits managers in the United States filled a prescription for at least one medication classified as a "drug of concern," according to established criteria known as the Beers list. Of those claims, half were for medications--including the antidepressant amitriptyline and anti-anxiety medication diazepam (ie, Valium)--with potential for severe adverse effects in older adults.

Less than 15% of the US population is older than 65 years of age, but this age group accounts for nearly one-third of medication consumption. Further, older adults more often have multiple chronic conditions, increasing the likelihood that they take several medications concurrently. Many medications present increasing risk for people as they age because of changes in metabolism and excretion--effects that are complicated by the number of prescription medications taken.

The list of criteria for determining the appropriate use of medication in older adults living in nursing homes was developed in 1991 by a team led by Mark Beers, MD, at the University of California, Los Angeles, with input from of a panel of experts. In 1997, Dr Beers updated the original list for use in any setting. The list named 28 medications or medication classes considered inappropriate for use in older adults--14 of which were deemed by the panel to have potentially severe adverse outcomes when taken by older adults.

The Duke researchers analyzed the prescriptions filled for all patients older than 65 who filed claims in 1999 through the outpatient prescription claims database of a large pharmaceutical benefits manager. The study population included representatives of all 50 states, the District of Columbia, Puerto Rico, and two US territories.

Of the 765,423 people in the study, more than 20% (162,370) filled a prescription for one or more medications of concern during the year. Although most patients who made such a claim filled a prescription for a single Beers list medication, nearly 16% (25,550) made claims for two high-risk medications, and 4% (6,402) filled prescriptions for three or more Beers list medications within the same year.

The findings suggest that some physicians may be uninformed about the increasing risks presented by common medications as people age. Others might be familiar with the Beers list but believe that a medication's benefits outweigh the risks in some situations.

The researchers note that pharmaceutical claims databases could serve as a tool to help correct the problem by screening prescriptions and issuing patient-specific alerts when physicians prescribe inappropriate medications or medication combinations. Physicians' compliance with the guidelines also might be improved by bolstering the clinical evidence of risks presented by particular medications when taken by older adults, who rarely are included in clinical trials that generate information about medications' side effects.

Many Drugs Prescribed for Elderly Americans Are Risky (news release, Durham, NC: Duke University Medical Center, Aug 9, 2004) http://news.mc.duke.edu/news /article.php?id=7994 (accessed 18 Aug 2004).