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Elderly Often Prescribed Inappropriate Mood-Altering Medicines

WebMD Health News

Oct. 3, 2000 (Atlanta) -- If you are elderly, or have elderly parents, take note: The next time you or your mother or father visit a clinic, the result could be a prescription for a drug that is inappropriate.

According to findings of a study presented Tuesday at a conference here, a quarter of all clinic visits in which elderly patients are prescribed psychotropic -- or mood altering -- medications involve drugs that may not be appropriate for them.

"Our ... findings indicated that 8.7% of all visits to clinics involved a psychotropic agent" being prescribed, lead study author Jane Mort, PharmD, told the audience. "When we looked at the prescribing of those psychotropic agents, we found that one out of four visits involved a psychotropic agent that was inappropriate. When you project that, it equates [to] 4.5 million visits in which an inappropriate agent was prescribed."

Mort and her colleague Rajender Aparasu, PhD, both from the College of Pharmacy at South Dakota State University, used information from two surveys, both conducted in 1996, to research the topic. They found that the most frequently prescribed psychotropic drugs -- and those most often involved in potentially inappropriate prescribing incidents -- were antidepressants, followed by anti-anxiety medications.

Inappropriate medication can lead to many problems, with high costs to both the patient and society. For example, long-acting benzodiazepines, which are used to treat anxiety, can make walking more difficult; for a patient with a history of falls, this could be a recipe for a fracture. Amitriptyline, an antidepressant, can cause constipation, blurred vision, and problems with walking. Both of these medications are at the top of the list of the drugs that are most commonly prescribed inappropriately, and for both, there are alternatives that have fewer side effects.

Among the researchers' other findings: being an older patient, having been seen at a clinic before, and being prescribed an antidepressant were all associated with an increased chance of getting a prescription that might be inappropriate. Factors that were associated with a lower chance of getting a potentially inappropriate prescription included being prescribed an antipsychotic agent, having Medicaid, and going to a clinic in a metropolitan area or in the Northeast. The study's findings are to be published in the journal Archives of Internal Medicine.

One expert says these findings are important because, as the population ages, general practitioners who may not be familiar with treating seniors are seeing more older patients.

"Disease management in the elderly is different than treating younger adults," Michelle Byrne, PharmD, tells WebMD. "And knowing how to avoid drug misadventures in elderly people is paramount to reducing [illness] and mortality. This goes to show that more education is needed." Byrne, an assistant professor of clinical pharmacy at the Massachusetts College of Pharmacy and Health Sciences and the clinical pharmacy consultant at Boston University Geriatric Services at Boston Medical Center, was not involved with the study.

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