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Seniors getting risky drugs

Medicines deemed hazardous to the elderly are still too often prescribed, researchers have found.

August 16, 2004|Valerie Reitman | Times Staff Writer

Many older Americans are getting prescription drugs that could be particularly dangerous for them.

In a large study of prescription claims filed for reimbursement, Duke University researchers found that about 21% of elderly patients had filled prescriptions for drugs that are known to cause harm or induce harmful side effects in those over age 65. They include antidepressants, painkillers such as Demerol, and sedatives such as Valium.

More than 15% of patients had filled prescriptions for two of the potentially harmful drugs and 4% had gotten three or more, according to the study, published in the August issue of the Archives of Internal Medicine.

The findings indicate "a significant failure in the American health care system," wrote Dr. Knight Steel, chief of geriatrics at Hackensack University Medical Center, in an editorial accompanying the analysis of 765,423 claims by elderly patients. Even if the study had turned up half as many hazardous prescriptions, he wrote, it would still be "shocking and warrants immediate and thoughtful action."

The study underscores the need for more vigilance by physicians about the drugs they are prescribing to elderly people, whose organs don't metabolize or excrete drugs as quickly as those of younger people.

The hazards are compounded when taking multiple drugs that might not interact well together.

Though the study was done with data from 1999, lead researcher Lesley H. Curtis says the problem has not likely improved in recent years, because other studies have turned up similar findings.

Steel said in an interview that he thinks the danger is probably far greater than the study suggests. Older adults take many drugs, he pointed out, and the study didn't consider the drugs administered at nursing homes and hospitals, which, he wrote, "are known to have a high prevalence of inappropriate prescriptions."

For instance, he noted that meperidine (the generic name for the painkiller Demerol) is widely prescribed, though it relieves pain only for a few hours and remains in the system for about a day, potentially causing seizures and confusion.

The reasons for the problem, say the authors and other experts, include the fact that physicians generally take only one course in pharmacology, receiving much of their information about drugs from pharmaceutical company representatives. While the potential hazards of each drug are outlined in the 3,000-page "Physicians Desk Reference," physicians have so much to keep up with between drug interactions and patients' conditions, they are often overwhelmed. The most commonly prescribed of the potentially harmful medications are psychotropic drugs, including tricyclic antidepressants (amitriptyline, Doxepin), pain killers and sedatives. Among the more commonly known drugs are Valium (generic name diazepam) and Librium (chlordiazepoxide clidinium). Other drugs considered less dangerous, but still potentially harmful, are the pain relievers indomethacin, cyclobenzaprin and carisoprodol, the allergy/anti-anxiety drugs hydroxyzine and promethazine, and the incontinence drug oxybutynin.

The study did not include nonprescription drugs and supplements, which can also have harmful effects.

Curtis, an assistant professor at Duke University Medical Center, suggested that seniors not only should review all the medication they are taking with their physician, but also consult their pharmacist. She suggested that insurance company computers be programmed to flag potentially harmful drug prescriptions given to the elderly, particularly when Medicare, the federal government's health insurance for the elderly and disabled, begins drug coverage.

While some drugstores have installed computer systems to review all the medications a patient is taking, Curtis said it isn't clear how reliable the systems are.

Steel recommended that physicians not be allowed to prescribe all drugs, such as those used to treat cancer or other ailments outside their specialties. He also advocates disciplinary measures if a physician frequently prescribes inappropriate drugs.

"The system reeks," said Steel, who also is a professor of medicine at the University of Medicine and Dentistry of New Jersey.

"I'm not sure why the country is not more up in arms. When you get into an airplane to fly to New York, you're reasonably confident that the plane's not going to crash. That's because systems are in place to prevent that. We need more systems."

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