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Unsafe Medications Often Prescribed For Elderly

Substantial Errors Still Exist in Prescriptions for Elderly, Especially Women
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WebMD Health News

Feb. 9, 2004 -- Memory problems, dizziness, or confusion in senior citizens could be side effects of antidepressants and pain medications that are known to be inappropriate for the elderly.

During 2000 alone, an estimated 17 million outpatient visits made by elderly people involved 38 prescription medications known to cause adverse side effects in older people, reports lead researcher Margie Rauch Goulding, PhD, a CDC epidemiologist in this week's Archives of Internal Medicine.Among the drugs causing the most problems:

  • Darvon (a pain medication), Elavil (an antidepressant), and Valium (an anti-anxiety drug) are "a large and persistent part of the problem," says Goulding. She says these are on the "always avoid" list -- a list of inappropriate drugs for the elderly created by experts in geriatric medicine and pharmacology.
  • Atarax (an antihistamine also prescribed for anxiety) and the urinary tract relaxant Ditropan are among the "always avoid" or "rarely appropriate" drugs.

Since 1997, doctors have been advised about these and similar drugs that can cause serious side effects like memory problems, confusion, dizziness, falls, and fractures, even high blood pressure and high blood sugar or hypoglycemia, Goulding tells WebMD.

Nationwide Evidence

Her study involved medical records of more than 8,100 outpatient visits made by senior citizens to doctors' offices and hospitals.

In 2000, nearly 8% of these visits involved medications on the "always avoid" list -- a number similar to a 1995 study, reports Goulding.

"Unfortunately, we're not seeing a decline," she tells WebMD. "This study points to the magnitude of the problem."

Other findings:

  • Elderly women were twice as likely to get inappropriate prescriptions than were men over age 65.
  • The risk of getting inappropriate prescriptions was higher for patients already taking several medications.

What drives doctors' drug choices when safer options are available? "They may be used to prescribing older drugs, which are less expensive," Goulding says. "Doctors may not be aware of the risks to elderly patients. In some cases, doctors may be responding to a patient's demand since pain medications can be addicting."

When side effects appear, neither the doctor nor the patient typically links them with the drug -- leading to more needless visits, she adds.

Talk to Doctors, Watch for Symptoms

"Doctors either aren't aware of these adverse effects -- or they aren't taking time to familiarize themselves with them," says Bernard A. Roos, MD, director of the geriatrics programs at the University of Miami School of Medicine and the Veterans Administration Medical Center in Miami. He commented on Goulding's study.

For example, "anxiety medications are among the most abused drugs," he tells WebMD. "Some should be used for as short a period of time as possible, preferably less than six months."

With chronic use, Valium and similar drugs produce increasing daytime sleepiness in senior citizens, adds Roos. "There are also significant brain function and motor problems that can cause confusion and falls."

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