Dangerous Prescriptions for the Elderly

Article excerpt

According to gerontology experts, the inappropriate use of prescription drugs may cause adverse drug reactions that may lead to subtle deterioration of function or precipitate medical crises, resulting in hospitalization or death.

In July 1995, the General Accounting Office issued a report on the extent of this problem, its causes, and emerging trends in health care delivery that may affect drug prescribing for the elderly. Our study was based on a literature review and documents obtained from leading researchers in the fields of gerontology and elderly clinical pharmacology. We interviewed these individuals and representatives of the Food and Drug Administration (FDA), the Health Care Financing Administration (HCFA), state Medicaid programs, industry trade associations, senior citizen and consumer advocacy groups, and medical associations who are knowledgeable in the use of prescription drugs for the elderly. We also analyzed data on prescription drug use from HCFA's 1992 Medicare Current Beneficiary Survey.

The following will focus on the factors that contribute to inappropriate use of prescription drugs among the elderly and their potential health and economic consequences. I also would like to highlight practices used and the health care industry's role in reducing inappropriate drug use among the elderly.

Extent of the Problem

Our analysis of 1992 data found that about 17.5% of almost 30 million Medicare recipients were still prescribed drugs that were generally unsuitable for their age group. While this is an improvement over the almost 25% reported for 1987 data, the inappropriate use of prescription drugs remains a significant health problem for the elderly. Insufficient coordination of patient drug therapies and weaknesses in communication among providers, pharmacists, and patients have compounded this problem. Inappropriate prescribing practices and the ensuing drug use have caused many elderly persons to suffer adverse effects that, according to the FDA, have resulted in $20 billion in hospitalizations each year. States, advocacy groups, and physician and pharmacy organizations have, however, taken a number of measures to reduce the incidence of inappropriate drug use. In addition, managed care, pharmacy benefit management, and other coordinated health care systems have features that have the potential to reduce inappropriate use of prescription drugs among the elderly.

The factors leading to the inappropriate use of prescription drugs are multifaceted and interconnected. They can reflect the behavior of the physician, pharmacist, and patient, either collectively or individually. From the time a drug is prescribed to the time when the drug is taken, many possible interrelated events can result in an adverse drug reaction or other serious effects.

Insufficient Coordination. The inappropriate use of prescription drugs can take several different forms. These range from potentially life-threatening drug-drug interactions to unnecessary therapeutic duplication--that is, using two or more similar drugs to treat the same problem. These inappropriate uses yield few benefits at increased costs. For example, an elderly woman who was taking hypertension medication visited her doctor after she began experiencing chest pain and tingling in the hands. The doctor prescribed four additional medications to treat these symptoms. When she took the prescriptions to be filled, her pharmacist identified the symptoms as side effects of the hypertension medication she was taking. The pharmacist contacted the physician, who prescribed a different hypertension medication.

Compounding the problem of insufficient coordination are incomplete physician and pharmacy records of patient conditions, allergies, and current therapeutic regimens. In addition, physicians may prescribe incorrect dosages, pharmacists may not recognize possible drug-drug or allergic reactions, and patients may not take medications as prescribed. …