Aug. 9, 2004 -- Millions of elderly Americans are taking prescription drugs that are widely considered to be too dangerous for them, new research suggests.
Investigators from Duke University report that over the course of a year, one in five people 65 or older filled prescriptions for at least one "drug of concern," and some were prescribed three or more inappropriate drugs even though less risky alternatives are available.
The findings suggest that as many as 7 million Americans over the age of 65 are taking unsuitable drugs.
"Given that there are clear alternatives for most patients, the fact that 21% of elderly people were prescribed these inappropriate drugs is very troubling," senior researcher Kevin A. Schulman, MD, tells WebMD. "This is an important component of (multiple drug interaction problems) in the elderly and it clearly needs a lot more attention than we have been giving it."
Mood-Altering Drugs Top the List
People over the age of 65 make up less than 15% of the U.S. population, but they account for nearly one-third of the drug prescriptions. The elderly are far more likely than younger people to take multiple prescription medications, and they are also more likely to have adverse reactions to drugs due to age-related changes in metabolism and kidney function.
With this in mind, a list of prescription medications considered inappropriate for use by nursing home residents was developed in the early 1990s and later revised to include all elderly people. Known as the Beers list, the guide includes 28 medications or classes of drugs that should be avoided in elderly people.
Many of the drugs included on the Beers list may cause problems with thinking and alertness, particularly in elderly people. In addition to the fact that these drugs are more likely to interfere with other drugs that elderly people are likely taking, these sedating drugs may also increase the risk of falling. Falling, which often leads to serious accidents, such as a broken hip, are a large cause of injury and even death in the elderly.
Drugs on the list are more likely to cause mood changes or drowsiness and include:
- Elavil (amitriptyline)
- Librium (chlordiazepoxide)
- Valium (diazepam)
- Adapin and Sinequan (doxepin)
- Dalmane (flurazepam)
- Atarax (hydroxyzine)
- Meprobomate (a barbiturate similar to phenobarbital)
- Soma (carisoprodol)
- Parafon Forte (chlorzoxazone)
- Flexeril (cyclobenzaprine)
- Skelaxin (metaxalone)
- Robaxin (methocarbamol)
In this study, Duke researchers reviewed prescription drug claims during 1999 for more than 765,000 people aged 65 and over enrolled in a major medication benefits group. Twenty-one percent filled prescriptions for drugs on the Beers list, and 4% of these patients filled prescriptions for three or more of the drugs.
The two most widely prescribed Beers drugs were the psychotropic drugs Elavil and Adapin, which accounted for just over half of the claims for drugs on the list with potentially severe adverse side effects. These drugs are commonly given at low doses to help elderly people sleep.
The study findings are reported in the Aug. 9/23 issue of the Archives of Internal Medicine.
"Most of the drugs on this list have fallen out of favor for use in general because there are newer and safer alternatives," American Geriatric Society spokesman Todd Semla, PharmD, tells WebMD. "The longer-acting psychotropic drugs are especially risky for older people because the risk of adverse events like hip fractures from falls is so great."
Study Underestimates Problem
In an editorial accompanying the study, geriatric medicine specialist Knight Steel, MD, wrote that the Duke findings probably underestimate the extent of the problem of inappropriate drugs among the elderly "by a wide margin."
Steel concluded that the problem could be addressed through several relatively simple interventions, including prohibiting payment for inappropriate drugs by Medicare and making a computer program available to all pharmacists identifying the drugs in question.
Steel tells WebMD that the use of inappropriate drugs and the overuse of prescription drugs in general are major causes of death and disability among the elderly.
"Just an hour ago I was talking to an 80-year-old who was taking 17 drugs," he says. "Taking 10 or 12 medications is common, and that is too many. We have to change the way we do things so that we get the correct drugs to the right people in the right doses at the right time."