Many elderly patients take inappropriate medicines
Patient safety outside the nursing home cited
An alarming number of elderly patients are taking medications that aren’t appropriate for them, according to a new study by the Agency for Health Care Research.
About one-fifth of the approximately 32 million elderly Americans not living in nursing homes in 1996 used one or more of 33 prescription medicines considered potentially inappropriate, the report says. Nearly one million elderly used at least one of 11 medications that a panel of geriatric medicine and pharmacy experts advising the researchers agreed should always be avoided in the elderly. These 11 medications include long-
acting benzodiazapines, sedative or hypnotic agents, long-acting oral hypoglycemics, analgesics, antiemetics, and gastrointestinal antispasmodics.
"This important research indicates that patient safety issues can occur outside hospitals, nursing homes, and institutional settings, and among any patient population. This study highlights the need to develop evidence-based programs and ways to improve prescribing practices in the United States," says John M. Eisenberg, MD, director of the Agency for Healthcare Research and Quality.
The study also suggests that elderly women and elderly people who are in poor health and who use more prescriptions are more likely than others to receive inappropriate drugs.
The list of potentially inappropriate medications reflects the consensus of the expert panel. Not all physicians agree about the appropriateness of specific drugs for the elderly. This lack of consensus stems in part from the limited amount of evidence of risks and benefits for some medications because older patients often are excluded from drug clinical trials due to their age and other medical problems.
The actual extent of inappropriate medication being prescribed may be much higher because of the conservative criteria the researchers used and because of the rapid rate that new pharmaceutical agents are being introduced into the marketplace, says Chunliu Zhan, MD, PhD, lead author of the study. The problem is compounded by suboptimal prescribing, including underuse of effective medications, inappropriate dosages, inappropriate combination of drugs, and other errors, Zhan says.
The study, "Potentially Inappropriate Medication Use in the Community-Dwelling Elderly: Findings from the 1996 Medical Expenditure Panel Survey," was published in the Dec. 12, 2001 issue of the Journal of the American Medical Association.
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