Many medications for elderly are prescribed inappropriately

Approximately one in five prescriptions to elderly people is inappropriate, according to a study published Aug. 22 in the open access journal PLOS ONE.

23 aug 2012--The authors of the study, led by Dedan Opondo of the Academic Medical Center in Amsterdam, conducted a systematic review of English-language studies of medication use in the elderly and found that the median rate of inappropriate prescriptions was 20.5%.

Some of the medications with the highest rates of inappropriate use were the antihistamine diphenhydramine, the antidepressant amitriptyline, and the pain reliever propoxyphene.

More information: Opondo D, Eslami S, Visscher S, de Rooij SE, Verheij R, et al. (2012) Inappropriateness of Medication Prescriptions to Elderly Patients in the Primary Care Setting: A Systematic Review. PLoS ONE 7(8): e43617.doi:10.1371/journal.pone.0043617

Provided by Public Library of Science

List Of Medications That Put Elderly Patients At Risk: The PRISCUS List

In the current issue of Deutsches Arzteblatt International (Dtsch Arztebl Int 2010; 107[31-32]: 543-51), Stephanie Holt, a clinical pharmacologist, and coauthors present the PRISCUS List: a list of medications that carry an increased risk of side effects when given to elderly patients.

27 aug 2010--The authors present the new list, which was developed specifically for Germany in the setting of a joint project entitled PRISCUS (Latin for "old and venerable"), and discuss its potential applications. Most patients take more medications as they grow older and thus run a greater risk of drug interactions and side effects. Medications that might cause side effects more frequently in elderly patients than they do in the overall population are called potentially inappropriate medications (PIM). A number of PIM lists already exist for countries other than Germany; these cannot be applied directly to the German situation because of differences between countries with respect to drug approval, prescribing practices, and treatment guidelines. The experts who created the PRISCUS list for Germany, proceeding on the basis of a literature search and a qualitative analysis of existing PIM lists from other countries, judged 83 medications to be potentially inappropriate for elderly patients. The authors of the article call the PRISCUS list an important aid in medical decision-making.

Source:
Prof. Petra A. Thuermann
Deutsches Aerzteblatt International

Seniors Mixing Prescription and O.T.C. Drugs

By RONI CARYN RABIN
09 jan 2009--Almost 70 percent of older adults who take prescription medications also use non-prescription drugs, dietary supplements or both, researchers have reported, and one in 25 older adults is at risk of suffering a bad reaction to a poor combination of drugs.

Older people also are using more medications than in the past, the scientists also found. Almost one third take more than five prescription drugs, and more than half rely on a combination of five or more prescription drugs, over-the-counter drugs and dietary supplements.

The study, published recently in the Journal of the American Medical Association, analyzed a nationally representative sample of more than 3,000 adults, ages 57 to 85, who were surveyed between June 2005 and March 2006.

The analysis found that more than 90 percent of older adults were regularly taking at least one medication, usually a prescription drug, and nearly half regularly used an over-the-counter drug or dietary supplement. Prescription drug use increased with age and was highest among those ages 75 to 85.

Among the findings:

* Some 68 percent of those who were taking a prescription medicine also were using an additional over-the-counter drug, dietary supplement or both.

* Nearly half of the potential drug-drug interactions identified by the researchers involved the use of anticoagulants like warfarin along with antiplatelet drugs like aspirin.

* More than half of the potential adverse interactions involved use of two over-the-counter substances, like ginkgo biloba and aspirin.

* Women were more likely to use prescription medications and dietary supplements, but men were more likely to suffer from an adverse drug interaction.

* Even though men and women reported similar rates of cardiovascular disease, far fewer women were taking cholesterol-lowering statins.

* Older Hispanics were less likely than other groups to be taking medications.

“People may perceive drugs that they can obtain without a prescription as safer than prescription drugs, but what makes them less safe is that no one knows you’re taking them,” said Dr. Stacy Tessler Lindau, assistant professor of obstetrics and gynecology and medicine-geriatrics at the University of Chicago Medical Center and a senior author of the paper.

Elderly people who purchase over-the-counter drugs, she added, “should get in the habit of buying them at the pharmacy counter and ask the pharmacist, ‘How will this interact with the other drugs I’m taking?’”

U.S. hospital, doctor visits balloon, survey finds

By Maggie Fox, Health and Science EditorFri Jun 29, 5:12 PM ET
Hospital and doctor visits in the United States have surged by 20 percent in the past five years and the most commonly prescribed medications are antidepressants, according to statistics published on Friday.
The survey by the U.S. Centers for Disease Control and Prevention also found most people who visited emergency rooms had private health insurance, although the uninsured were twice as likely to use emergency services as people with insurance.
The report estimates that 1.2 billion visits were made to hospitals, emergency rooms and physicians' offices in 2005.
"It was only a few years ago that we released that the total number of visits had reached 1 billion. And now we are up to 1.2 billion," Catharine Burt of the CDC's National Center for Health Statistics said in a telephone interview.
"That's a 20 percent increase in the just the last five years -- a huge number," said Burt. "I can tell you that the number of hospitals and physicians has not increased 20 percent."
The reason is clear -- Americans are getting older. "When you reach 50 things start going wrong, just little by little, and you keep going back to the doctors," Burt said.
The baby boom generation -- born between 1946 and 1964 -- are now prime users of the medical system.
Burt's team surveyed 352 hospitals and about 1,200 physicians throughout 2005 for the study.
OLDER AND DEPRESSED
Of 2.4 billion drugs mentioned in patients' medical records in 2005, 118 million were antidepressants, Burt found. High blood pressure drugs followed, with 113 million and arthritis or headache drugs were mentioned in 110 million.
"These are visits. These aren't people," she said. People taking antidepressants may need more frequent doctor visits.
The report also shed light on the controversial issue of emergency room visits. Many health care experts are worried that the 43 million people who lack health insurance in the United States must rely on emergency rooms for care -- not the best way to prevent serious conditions.
The survey suggests this is true. "People with no insurance are twice as likely to use the emergency department as the privately insured," Burt said.
Nearly 28 percent of all doctors visits by uninsured people are to emergency rooms, compared to 6.6 percent of visits made by people with insurance.
The report found that 46 million of the visits made to ERs in 2005 were by people with insurance, compared to 19 million by people without insurance.
"With 315,000 people visiting emergency departments every day, the alarm bells are sounding and policymakers should heed the alert and respond," said Dr. Brian Keaton, president of the American College of Emergency Physicians, which is pressing for a national commission on access to emergency medical services.
The CDC report is available on the Internet at http://www.cdc.gov/nchs/data/ad/ad388.pdf.