Many Elderly Too Medicated, Survey Finds
Confirming long-held suspicions about the over-drugging of the elderly, a Harvard University study has found that almost one-quarter of the United States’ senior citizens--6.6 million people over age 65--are being prescribed drugs that have been deemed dangerous to the health of older people.
The study, which appears in today’s issue of the Journal of the American Medical Assn., marks the first time that researchers have been able to document the vast extent of the problem. Although previous studies have shed light on the practice of inappropriate medication in nursing homes, the Harvard study looked at elderly people living in the community.
The authors found that in 1987, the most recent year for which statistics are available, 23.5% of older Americans received at least one “potentially inappropriate” drug based on a list of 20 medications that a panel of experts has concluded should be prescribed to the elderly only in the rarest of circumstances.
The research highlights what one expert termed “an epidemic of inappropriate, sub-optimal and excessive drug prescribing for older Americans”--a problem the study authors say stems from gaps in doctors’ knowledge about how drugs affect the elderly and aggressive marketing by drug companies. Experts, including the authors, said the research only scratches the surface.
“We believe that at least half, probably two-thirds of older adults in this country are being prescribed a drug that is doing unnecessary harm to them and the toll is enormous,” said Dr. Sidney M. Wolfe, director of Public Citizen’s Health Research Group in Washington, which published a book on elderly drug use earlier this year. “The problem, as serious as it is stated in the JAMA paper, is actually much worse.”
Doctors who specialize in geriatrics say they routinely see evidence of over-drugging in their practices. Dr. Gary Small, a geriatric psychiatrist at UCLA, frequently advises other doctors whose elderly patients have illnesses that seem to bring about mental changes. Often, Small said, drugs are the culprit.
“I can recall, when I first started out in this area, seeing a patient who had a diagnosis on admission to the hospital of Alzheimer’s disease but was also taking 10 milligrams of Valium a day,” Small said. “I discontinued the Valium and his mental impairment cleared up in a couple of weeks.”
In fact, Valium, often prescribed as a sleeping pill, was one of the drugs cited in the JAMA article as being one of the most commonly prescribed medications that is dangerous to the elderly. Librium, another sedative, also was on the list.
The problem with these drugs, said Dr. Steffie Woolhandler, an associate professor of internal medicine at Harvard and one of the study’s authors, is that they do not wear off by morning. Senior citizens are left sleepy and confused, and therefore prone to falls and hip fractures.
Other drugs deemed dangerous for the elderly were Darvon and Darvocet, both addictive narcotics. The Harvard researchers said these drugs are no more effective than aspirin for pain and can cause seizures and heart problems in older people.
Experts say there are other, safer, alternatives. For example, there are tranquilizers whose effects are shorter-lasting than those of Valium and Librium. And, Woolhandler said, some patients might not need drugs at all. Doctors, she said, need to make a greater effort at solving problems without medication.
“It’s easy to write a prescription,” she said. “It’s much more time-consuming to ask, ‘Are you drinking too much coffee during the day? Are you getting enough exercise? Is something bothering you that is keeping you up at night?’ ”
Woolhandler blamed the over-drugging problem on aggressive marketing by drug companies, which spend an estimated $10 billion each year to advertise and promote new drugs, mostly through seminars and one-on-one sessions with doctors. She also blamed a lack of skepticism among physicians, who rely on the companies to educate them about how to use different medications.
“The drug company salesmen are trying to convince physicians that for every human problem the answer is the latest new drug,” she said. “So much money is spent on the miseducation of physicians by drug companies. Too little is spent on spreading real scientific information about drugs.”
But a spokesman for the Pharmaceutical Research and Manufacturers of America, an industry trade group, countered that what drug companies tell doctors is highly regulated by the U.S. Food and Drug Administration, precisely to prevent manufacturers from misleading doctors.
“The issue here is making sure that physicians know about how to use medicines,” spokesman Steve Bercham said. “We play a vital role in that. Who knows the drug better than the drug companies?”
Bercham also complained that the study is outdated because prescribing practices have changed since 1987 as doctors have become more attuned to the special needs of the elderly. But Woolhandler said she has no reason to believe that practices have changed dramatically since then.
Small, the UCLA doctor, said he frequently sees patients who are taking the drugs cited in the study. When asked to bring in their medications, Small said, some patients arrive with shopping bags filled with pill bottles. Often, the prescriptions are old; when people change doctors, Small said, the new physicians don’t want to take patients off medications they have been using for years.
Some drugs that are fine for younger people may pose dangers to older people, whose livers and kidneys may not function well enough to absorb the medications. According to Wolfe, the consumer advocate, adverse reactions to drugs by people over 60 account for more than 650,000 hospitalizations each year.
Wolfe said an estimated 60,000 people each year become afflicted with drug-induced Parkinson’s disease, the result of medications widely prescribed for heartburn and indigestion. About one-seventh of all hip fractures in the United States occur when elderly people fall as a result of being disoriented by a prescription drug, he said.
The Harvard researchers drew their data from profiles of 6,171 patients who participated in the most recent National Medical Expenditure Survey, conducted by the federal government.
But the researchers were only able to look at individual drugs the patients were taking. They could not assess the extent of other important problems--drugs that are prescribed in doses too large for the elderly, and drugs that become dangerous when taken in combination with one another.
“We were only able to look at one type of dangerous prescribing,” Woolhandler said. “Our definition of bad prescribing was a very limited and partial one.”
Caution on Drugs
Nearly one-fourth of all older Americans are prescribed drugs that may be dangerous for them, according to a new study by Harvard University. The following are the seven most commonly prescribed dangerous drugs; each are given to more than 500,000 senior citizens each year.
A word of caution: Experts advise senior citizens who are taking these drugs not to stop on their own. First, consult a doctor who can supervise a withdrawal or a switch to a safer alternative.
* Dipyridamole (Persantine): Blood thinner designed for patients with artificial heart valves.
* Propoxyphene (Darvon, Darvocet): Addictive narcotic no more effective than aspirin for pain. Can cause respiratory failure at low doses when combined with alcohol. Also can cause seizures and heart problems.
* Amitriptyline (Elavil, Limbitrol, Triavil, Etrafon, Endep): Antidepressant that often causes difficulty urinating, dizziness and drowsiness that may cause falls. Can worsen confusion and glaucoma.
* Chlorpropamide (Diabinese): Pill to lower blood sugar in diabetics. Can cause dangerous fluid retention.
* Diazepam (Valium): Sedative/sleeping pill. Its potency can keep many senior citizens sleepy all day and prone to confusion, falls and hip fractures.
* Chlordiazepoxide (Librium): Sedative/sleeping pill. Its potency keeps many senior citizens sleepy all day and prone to confusion, falls and hip fractures.
* Indomethacin (Indocin): Pain reliever and anti-inflammatory medication that can cause confusion and headaches. Also risk of bleeding from the stomach.
SOURCE: The Cambridge Hospital/Harvard Medical School
