November 2004

Elderly patients often given inappropriate medicine

Prescribing of inappropriate medications for elderly patients appears relatively common, according to an article in the August 9/23 issue of The Archives of Internal Medicine, one of the JAMA/Archives journals.

According to information in the article, while people 65 years or older make up less than 15% of the population, they account for nearly one‑third of prescription drug users. Elderly persons are also more likely to take several drugs concurrently, the article stated.

Lesley H. Curtis, PhD, of Duke University Medical Center, Durham, NC, and colleagues investigated the extent of potentially inappropriate medication prescribing for elderly patients not in the hospital. Inappropriate medications were identified according to criteria set by physicians and pharmacologists, as defined by a list of drugs to be avoided in the elderly known as the Beers revised list of drugs.

The researchers studied a large national pharmaceutical benefit company's outpatient claims database, which included 765,423 patients aged 65 or older who filed one or more prescription drug claim during 1999. They found that 162,370 patients (21%) filled a prescription for one or more drugs of concern (medications that should be avoided in elderly patients or which are inappropriate for use in elderly patients).

Amitriptyline and doxepin (drugs used for treatment of depression) accounted for 23% of claims for Beers list drugs, and 51% of those claims were for drugs with potentially harmful effects. More than 15% of patients filled prescriptions for two drugs of concern, and 4% filled prescriptions for three or more drugs of concern within the same year.

"The common use of potentially inappropriate drugs should serve as a reminder to monitor their use closely," the authors wrote. "Pharmaceutical claims databases can be important tools for accomplishing this task, though clinical and laboratory data are needed to improve the sensitivity and specificity of patient‑specific alerts."

In an accompanying editorial, Knight Steel, MD, of Hackensack (NJ) University Medical Center, wrote that the article by Curtis et al, "bespeaks a significant failure in the American health care system. Using a 1999 claims database of over three quarters of a million elderly subjects from a national pharmaceutical benefit manager, they report that 21% of this population filled a prescription for a drug deemed to be potentially inappropriate for this age group by an expert panel. Although the drugs included on such a list may vary depending on the views of the members of the panel, if even half that number of elderly subjects are taking potentially inappropriate medications, one in ten of all older persons is receiving a drug that is potentially not appropriate."

Dr. Steel stated that whatever the reason for the high rates of inappropriate prescribing to elderly patients, "the time has come to decrease the likelihood of inappropriate prescribing."

"One way to begin is to include pharmacists in the process of prescription writing in a more meaningful way. Since they usually have information about patients' age, pharmacists could be required to question the use of certain drugs or dosages in the elderly."

SOURCE: "Inappropriate Prescribing for Elderly Americans in a Large Outpatient Population," by Lesley H. Curtis, PhD, et al, Archives of Internal Medicine. Aug. 9‑13, 2004;164:1603‑1604.

NOTE: This article appeared in the World Chiropractic Alliance Health Watch electronic newsletter. To receive this free newsletter each week, sign up at www.wcanews.com