The High Rate of Inappropriate Prescriptions for Seniors

Just as children require medical treatment different from that of adults, seniors have specific health-care needs as well. As we’ve noted, elderly patients are more sensitive to some drugs, less to others, can present different symptoms of common conditions and often communicate differently from younger people.

They are also disproportionately large consumers of medication. A recent study published in PLoS One puts that reality into an uncomfortable context by concluding that inappropriate drug prescribing is common for elderly patients.

The risk, the researchers said, is about 1 in 5 prescriptions. The most common inappropriately prescribed drugs are:

  • propoxyphene (Darvon and other narcotic pain relievers);
  • doxazosin (alpha blockers to treat high blood pressure and other disorders);
  • diphenhydramine (Benadryl and other antihistamines); and
  • amitriptyline (Elavil and other antidepressants).

As reported on MedPage, the median rate of inappropriate prescriptions was 1 in 5, but the high end of the range was nearly 4 in 10. The authors wrote:

“Despite intensified efforts to scrutinize and improve the quality of medication prescription among elderly persons in the primary care setting, inappropriate medication prescriptions are still common.”

More than 1 in 3 at-risk older individuals experience drug-related adverse events, even in cases where less hazardous options are available, they noted.

The researchers reviewed 19 studies to assess the use by older patients of several classes of drugs including analgesics (pain relievers), hypnotics (sleep inducers), antihypertensives (for high blood pressure) and anticholinergics (for spastic and other disorders).

Some lower-risk drugs were more commonly prescribed than higher-risk drugs in the same category. For example, propoxyphene, which is classified as low risk, was the most common inappropriate medication, but higher risk drugs in the same class, such as Demerol, were the least commonly prescribed. Doxazosin, a low-risk drug, was the most common inappropriate antihypertensive prescribed, and guanethidine, a high-risk drug, was the least prescribed. Digoxin, which treats abnormal heart rhythms, was the most commonly used inappropriate medication, and disopyramide, a high-risk antiarrhythmic, was the least common.

But some high-risk drugs were commonly prescribed inappropriately. The high-risk anticholinergic diphenhydramine was most often used. (The least common in this class were belladonna alkaloids, which also are high risk.) The same was true for amitriptyline (most common) and doxepin (least common)-both are considered high risk. Ditto for muscle relaxants-cyclobenzaprine (Flexeril and others) was the most common, and metaxalone (Skelaxin) the least. Both are high risk.

All sedative hypnotics are considered high risk. In this class, diazepam (Valium) was the most used, and alprazolam (Xanax) and oxazepam (Serax) had the lowest rates.

Acknowledging that individuals respond differently to drugs within a given class, the researchers advise doctors generally to avoid the riskiest agents, and to monitor patients closely. They advocate a “decision support system” to alert doctors of potential side effects and interactions when they write prescriptions.

Surely we are not alone in thinking this is simply part of a doctor’s job-when you prescribe medicine to a patient, you must know, based on age, gender and full medical history-how it’s likely or even possible to affect that person, in ways both good and harmful.

When a doctor prescribes medication, always ask:

What is this medication for?
What will happen if I don’t take this medication?
When can I expect this medication to work for me?
What do I do if I have a problem with this medication?
Can I take this medication with all my other medications?

For more information, see my backgrounder about medication errors. To report an adverse event from taking a drug, call the FDA’s MedWatch program at (800) 332-1088 or file a report online.

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