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1 in 5 Rx’s for Seniors Is Inappropriate

The views expressed are those of the author and are not necessarily those of Scientific American.

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senior elderly prescription inappropriate

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Take two of these—or should that be three? Or one?

Congress recently took steps to improve the safety of children’s drugs. Now, a new study finds that those on the other end of the age spectrum also frequently receive medication that may put their health at risk.

Approximately 20 percent of prescriptions that primary care providers give to patients over the age of 65 are inappropriate, according to the study, published online August 22 in PLoS ONE. A medication is considered inappropriate if it has a higher risk of complication than a similarly effective drug, is insufficient to treat the problem for which it is prescribed, or is under-, over- or mis-prescribed. The researchers analyzed data from 19 previously conducted studies on prescription information for seniors.

“In spite of increasing attention to the quality of medication prescription among elderly persons presenting to the primary care setting, there are still high overall rates of inappropriate medication prescription,” wrote the study authors, led by Dedan Opondo, of the medical informatics department at the University of Amsterdam.

The most common medications to get inappropriate scripts for the older set are: the pain-reliever Propoxyphene (Darvon), the antidepressant Amitriptiline (Elavil, Endep, Vanatrip), the beta-blocker Doxazosin (Cardura) and the antihistamine Diphenhydramine (Benadryl, etc.). Some of these frequently mis-prescribed meds, including antidepressants and antihistamines, can have serious adverse consequences when not taken correctly, especially in the senior population. Those over the age of 65 are more likely than younger patients to be taking several drugs that might interact; may have have poor kidney and liver function, which can effect drug metabolism; and may have “disabilities like visual and cognitive decline,” which may put them at risk of accepting a prescription that is not right for them, the researchers noted.

The new meta-study only looked at seniors who lived in the community and not in assisted living or nursing homes. Previous analyses have found that some 40 percent of prescriptions given to those in nursing homes are not appropriate, possibly because nursing home patients are more likely to be on numerous medications. But is the rate is far too high.

The authors of the new study recommend continuing to push for more and better electronic decision-making tools, such as those that might accompany electronic health records. EHRs can track patients’ histories and other medications more easily and send alerts if doctors are prescribing a medication that carries higher risks than a similar drug or might interact with a med the patient is already taking. Indeed, a 2010 study, published in the Archives of Internal Medicine, found that computer drug ordering systems helped reduce prescription errors—especially for those 66 and up.

Katherine Harmon Courage About the Author: Katherine Harmon Courage is a freelance writer and contributing editor for Scientific American. Her book Octopus! The Most Mysterious Creature In the Sea is out now from Penguin/Current. Follow on Twitter @KHCourage.

The views expressed are those of the author and are not necessarily those of Scientific American.

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  1. 1. vmfenimore 9:31 pm 08/22/2012

    This article cites Propoxyphene as an example of a drug that has been inappropriately prescribed to the elderly. But when you click on the link for Propoxyphene it takes you to another article saying that this drug will no longer be available after Nov 19, 2010. Including a drug that is no longer prescribed in the study indicates to me a strong possibility that old data was being used to draw the study conclusion. Since it was decided that the drug Propoxyphene is “never” appropriate, it should have been eliminated from the study data.

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  2. 2. jtdwyer 7:18 am 08/23/2012

    The article states:
    “A medication is considered inappropriate if it has a higher risk of complication than a similarly effective drug…”

    Regardless of a medication’s associated statistical risk of complication, an individual may develop complications from one drug and not another – making a medication generally deemed “inappropriate” the most appropriate for an individual. Complications very often arise from specific drug interactions…

    If there are medications that are always “inappropriate” – that always produce more serious complications than other medications, they should be removed from the market. This can occur as new medications become available that should supersede older, less effective drugs with less risk, but medications must be specifically prescribed to meet patients’ conditions.

    As I understand, many medications, for example for depression always eventually produce serious side effects, and alternative medications must be used. In this case again, there is no clear cut ‘best medication’.

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  3. 3. mscottcgp 9:28 am 08/27/2012

    Federal law requires that all residents of skilled nursing facilities ( nursing homes) have their medications monitored at least every 30 days by a consultant pharmacist. Unfortunately, there is no such requirement for assisted-living facilities and adult foster care homes. These patient’s family physicians often have no continuing education training in geriatric medication and don’t review their meds periodically to eliminate inappropriate ones,As a consultant pharmacist, I am continuously dismayed to see patients transitioning from these facilities to skilled nursing facilities and the list of inappropriate medications they are on. Many times, the reason they end up in nursing homes is their family thinks that they are developing dementia when, in fact, these meds are causing dementia-like symptoms. Then, when the skilled nursing facility weans them off these meds per my recommendations, these symptoms disappear.
    I have also seen this happen in my family. My mother-in-law, because of a bipolar condition, resided in an adult foster-care home. My husband and I (we are both pharmacists) have had to stop many medications that were inappropriately prescribed for her, many times scratching our heads as to why her doctor would even consider using them.
    Consultant pharmacists save many seniors from drug errors and interactions daily. They are an valuable resource in the fight against inappropriate meds.. For more info on consultant pharmacists, check out The American Society of Consultant Pharmacists website ( for a list of senior care pharmacists in your area,
    Mary Scott, RPh, CGP (Certified Geriatric Pharmacist)

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