Are we unnecessarily drugging our seniors?
That’s the subtext of an analysis by public health researchers at Brown University which found that more than 1 in five seniors with Medicare Advantage plans got a prescription for a “potentially harmful high risk medication,” a.k.a. “Drugs To Avoid In The Elderly,” during 2009.
Researchers report that 21.4 percent of the patients — more than 1.3 million people — “received at least one high-risk medication, for which there is often a safer substitute.”
Getting a prescription for a “risky” medication (among a list of 110 drugs agreed upon by a group of clinicians and other experts) was more common in the Southeast, among women and people living in relatively poor areas, the study found. In terms of geography, it was least prevalent in New England; indeed, Worcester, Mass. had “the best rate of single and multiple high-risk prescription use, respectively,” researchers report.
Amal N. Trivedi, an associate professor of Health Services Policy and Practice at Brown said one of the key take-home messages is that patients should regularly “review their medication lists with pharmacists and their health care providers.”
(According to the report, high-risk medicines in the elderly are broadly defined as “medications that should be avoided among patients 65 years of age or older because the associated adverse effects outweigh potential benefits or because safer alternatives are available.)
The overall list of high-risk drugs includes a variety of medications, from anti-anxiety drugs and antihistamines to muscle relaxants, long-acting benzodiazepines, amphetamines, oral estrogen and barbituates.
Here’s more detail from the Brown news release:
The demographic trends in the analysis, based on Medicare data from more than 6 million patients, suggest that differences in the rates of prescription of about 110 medications deemed risky for the elderly cannot be explained merely by the individual circumstances of patients, said lead author Danya Qato, a pharmacist and doctoral candidate in Health Services Research at Brown.
“At the population level it is clear that there is a unique phenomenon occurring,” said Qato, lead author of the paper published in the current edition of the Journal of General Internal Medicine [but published online back in November]. “While one can reason that it might be appropriate for a particular patient to be on a particular medication, with such a preponderance of use of high risk medications in some locations versus others, our results suggest that we cannot attribute this variation wholly to patient characteristics…”
In another demographic analysis, women across the country had a 10 percentage-point greater likelihood of receiving a high risk prescription. Other differences were less stark. Generally the lower the socioeconomic status of a patient’s region, the more likely they were to receive a high-risk medication. Residents of the poorest areas had a 2.7 percentage point higher risk than the residents of the richest areas…
Qato and Trivedi said the explanation for the gender difference may be straightforward. Some of the high risk medications treat ailments specific to women or that are more common in women.
People living in poor areas, meanwhile, generally have less access to high quality health care, Qato said, although the connection between poverty and high-risk prescriptions requires further study.
The higher risk of receiving potentially harmful prescriptions in poor areas does not explain the geographic differences, Qato said. She and Trivedi accounted for the economic statistics in their geographic analysis and for geography in their economic analysis.
Instead the reasons why people in the South are at substantially higher risk than people in the rest of the country could be a combination of many, likely interconnected, factors, Trivedi and Qato said. The factors could include higher patient demand for the drugs, a different prescribing culture, possibly higher prevalence of chronic medical problems in the region, or inadequate medical training with regard to appropriate prescribing among elderly patients.
Trivedi said officials and health care providers should take the study as a cue to improve prescribing.
“Clinicians and policymakers should work to reduce the use of these potentially inappropriate medications in older patients, because their risks outweigh their benefits and safer alternatives exist,” he said.
As a pharmacist, Qato said she hopes the research encourages seniors to take greater ownership of their health care and to be more vigilant about their prescription drug use…