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Posted on 02.03.05
CERTs Study Finds Elderly Continue to Receive Risky Medications
By Martha C. Rundles
Nearly three in 10 elderly people enrolled in a group of health maintenance organizations (HMOs) received potentially inappropriate medication, according to a study by the HMO Research Network Centers for Education and Research on Therapeutics (CERTs). The study is published in the February 2005 issue of Journal of the American Geriatrics Society.
In the study, investigators examined rates of medication use in 157,517 people over an 18-month period from January 1, 2000, to June 30, 2001. Study participants were 65 years and older and members of 10 geographically distributed HMOs. Researchers looked specifically at the prevalence of use of 33 potentially inappropriate drugs among the elderly, derived in part from the 1997 Beers criteria of drugs to avoid by those 65 years and older. The list includes a range of pain killers, antidepressants, and muscle relaxants classified as risky for elderly consumption.
The researchers found that on average nearly one third, or 28.8 percent, of elderly people surveyed received at least one of the 33 medications from the list. Further, 17 percent received at least one of the 14 medications with some indications but are often misused; 13 percent received at least one of the eight medications rarely considered appropriate; and 5 percent of elderly patients received at least one of 11 medications classified as “always avoid.” Overall, the usage rates of such medications were greater in women (32.4 percent) than in men (24.4 percent).
At least 1 percent of elderly members received a drug classified by expert panels as “always inappropriate” in people over the age of 65, and 7 percent had received propoxyphene, a pain reliever considered rarely appropriate among elderly people.
“This study contributes to a large body of evidence using different methodologies showing that these medications continue to be used by substantial proportions of older patients,” said Steven R. Simon, MD, MPH, one of the investigators from the study and the paper';s lead author.
Another CERTs study was published in August 2004 on a similar topic. The University of Arizona Health Sciences CERTs center published findings from a study on suboptimal prescribing to the elderly, and the paper, “Inappropriate Prescribing for Elderly Americans in a Large Outpatient Population” (Curtis et al) appeared in Archives of Internal Medicine in August 2004. An article from the CERTs Web site can be accessed through the following link: http://www.certs.hhs.gov/whats_new/archive/2004/20040812_01.html.
Despite years of research and media attention on this issue, the HMO study underscores the need to improve the way medications are prescribed and used among elderly patients.
The HMO center has identified the need for further study to examine a potential association between these inappropriate medications and adverse outcomes. “Future study needs to examine the rates of adverse outcomes, such as hip fracture and sub-dural hematoma, associated with the use of these medications,” said Simon. “And additional work needs to explore what happens between prescriber and patient at the time these medications are prescribed.”
If there is evidence of an association between adverse outcomes and medication use, Simon said, the next step is finding ways to reducing the use of these drugs. He noted a variety of approaches to the issue, including formulary restrictions, computerized order entry with clinical decision support, educational outreach to physicians, and direct patient and administrative educational interventions.
Joining Dr. Simon were K. Arnold Chan, MD, ScD; Stephen B. Soumerai, ScD; Anita K. Wagner, PharmD, DPH; Susan E. Andrade, ScD; Adrianne C. Feldstein, MD, MS; Jennifer Elston Lafata PhD; Robert L. Davis, MD, MPH; and Jerry H. Gurwitz, MD.
Funding for the study was provided through a cooperative agreement from the Agency for Healthcare Research and Quality (AHRQ), www.ahrq.gov.