Many Older Patients on Risky Drugs

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http://www.forbes.com/lifestyle/health/feeds/hscout/2004/08/09/hscout520520.html

 

Many Older Patients on Risky Drugs

By Steven Reinberg

HealthDay Reporter

 

MONDAY, Aug. 9 (HealthDayNews) -- At least 20 percent

of elderly Americans are being prescribed drugs that

could possibly harm their aging bodies, new research

claims.

 

" There is a list of medications, called the Beers

list, that may not be appropriate for people over 65, "

said senior researcher Dr. Kevin Schulman, a professor

of internal medicine at Duke University. " The question

is, how often are those medications used in clinical

practice? "

 

" We found that one in five patients over 65 who

receive a prescription receive a prescription for one

of these medications. In fact, over 15 percent of

these patients receive prescriptions for two or more

of these medications, " Schulman said.

 

Worse yet, of the 765,423 people included in the

study, 4 percent were given prescriptions for three or

more risky drugs, according to the report in the Aug.

9 issue of the Archives of Internal Medicine.

 

The impact of the findings could be sizable: While

only 15 percent of the U.S. population is considered

elderly, this group consumes one-third of all

medications prescribed each year.

 

The scope of the problem was much larger than the

research team expected, Schulman added. The most

common cases involved antidepressants and muscle

relaxants, which can tax aging kidneys to the breaking

point.

 

In their study, Schulman's team collected data on

prescriptions filled for all patients over 65 who

filed claims in 1999 with AdvancePCS, a part of

Caremark Rx Inc. Patients hailed from all 50 states

and two U.S. territories.

 

Psychotropic drugs on the Beers list were the most

commonly prescribed to this older age group, making up

41 percent of the prescriptions. Prescriptions for the

antidepressants amitriptyline and doxepin (AdapinR,

SinequanR, ZonalonR) and the anti-anxiety drug

diazepam (ValiumR) made up almost a quarter of the

prescriptions. Second most common were prescriptions

for inappropriate muscle relaxants such as

carisoprodol, chlorzoxazone (Paraflex) and

cyclobenzaprine (Flexeril).

 

Most of the time, there is an alternative to these

medications, so physicians can use something that's

safer, Schulman noted.

 

" We have to pay a lot more attention to the potential

toxicity of the medications older people are taking, "

he said.

 

" People over 65 who are in good health don't realize

that their kidneys don't function as well and they

don't metabolize drugs as well as they did when they

were younger, " which is one reason some medications

can be harmful, Schulman explained.

 

" We are not always aware that there are problems with

these medications as we get older, " he added. " When

you get a prescription, make sure you ask your

physician if it is safe in those over 65. Is the drug

metabolized by the kidneys? Are you on the right dose,

given your age? "

 

Another expert agrees that action must be taken to

safeguard elderly patients.

 

" There is a fair number of inappropriately prescribed

drugs for elderly Americans, and it's time we did

something about it, " said Dr. Knight Steel, chief of

geriatrics at Hackensack University Medical Center.

 

Steel, who wrote an accompanying editorial in the

journal, added, " We really should have a system in

place that limits the prescription of inappropriate

drugs. "

 

Steel thinks the system could be improved if

pharmacists were more involved in the prescribing of

drugs, if there were computerized systems that worked

better, and if doctors were better-trained.

 

Steel believes the problem of prescribing the wrong

drugs is serious but unrecognized. If that many

schools had asbestos falling from the ceiling and that

many operating rooms were contaminated, " we would be

up in arms about it, " he said.

 

" We need a better system for prescribing drugs in a

way that maximizes the benefits and minimizes the

risks, " Steel said.