A third of older people may be prescribed ‘inappropriate drugs’

A study has found that older people in the United States who take these potentially harmful medications make more visits to the hospital and pay higher healthcare costs.

As people get older, they become more likely to experience adverse effects from taking certain medications.

To help doctors minimize this problem for their patients, the American Geriatrics Society publish a list of “potentially inappropriate medications.” These are drugs for which the risks for many older adults outweigh any potential benefits or where effective but less risky alternatives are available.

Among the drugs on the list are:

• antidepressants

• benzodiazepines

• barbiturates

• androgens and estrogens

• nonsteroidal anti-inflammatory drugs (NSAIDs).

• first-generation antihistamines

• antipsychotics

• proton pump inhibitors (PPIs)

A new analysis by researchers at the University at Buffalo, NY, suggests that 34% of individuals over 65 years of age received a prescription for at least one such drug between 2011 and 2015.

After adjusting for factors such as age, sex, race, income, insurance coverage, and various medical conditions, individuals who received the drugs were 17% more likely to be hospitalized than those who did not receive them.

They were also 26% more likely to visit the emergency room and 18% more likely to make outpatient visits.

On average, doctors prescribed these people more medications overall (8.7 vs. 4.5), and they faced additional healthcare costs of $458 per year, including an extra $128 for prescription drugs.

“The average age of the U.S. population is rising, and older adults account for a disproportionate amount of prescription medications,” says first author Collin Clark, PharmD, clinical assistant professor in the School of Pharmacy and Pharmaceutical Sciences at Buffalo. “Harm to older adults caused by potentially inappropriate medications is a major public health challenge.”

Although efforts to reduce the prescribing of potentially harmful medications, or “deprescribe,” have increased significantly over the past decade, there is still a long way to go, says his colleague David Jacobs, PharmD, Ph.D. assistant professor of pharmacy practice and the lead investigator of the study.

The study appears in the Journal of the American Geriatrics Society.

Annual household surveys

The analysis drew upon data from the 2011-2015 Medical Expenditure Panel Survey (MEPS), which the U.S. Public Health Service and the Centers for Disease Control and Prevention (CDC) conduct annually.

The survey collects information from a nationally representative sample of households about their use of healthcare services, the charges for those services, and how people pay for them.

The data were weighted to provide estimates for all individuals over 65 living in the U.S. during each year of the study period.

The researchers focused on prescriptions for 33 drugs or classes of drug that the American Geriatric Society list as potentially inappropriate for older people.

The overall prescription rate of these medications was 34% between 2011 and 2015. However, there was a small, statistically significant decline from 35.3% at the start of the study period to 32.5% at the end.

However, the prescribing of some of the most problematic drugs, such as benzodiazepines, NSAIDs, and PPIs, did not change.

The authors conclude:

“Interventions are needed to target unnecessary and inappropriate medications in older adults. Deprescribing is currently in its infancy in the United States, and further work is needed to implement these interventions to reduce unnecessary healthcare utilization.”

They acknowledge several limitations of their analysis. In particular, they note that, as an observational study, it did not prove a cause-and-effect relationship between prescribing of these drugs and increased hospitalizations, healthcare costs, and so on.

Other factors that the researchers did not account for may have played a role.

Written by James Kingsland on November 3, 2020 — Fact checked by Hannah Flynn, MS

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