Aug. 9, 2004 — Millions of elderly Americans are taking
prescription drugs that are widely considered to be too dangerous for them, new
research suggests.
Investigators from Duke University report that over the course
of a year, one in five people 65 or older filled prescriptions for at least one
“drug of concern,” and some were prescribed three or more inappropriate
drugs even though less risky alternatives are available.
The findings suggest that as many as 7 million Americans over
the age of 65 are taking unsuitable drugs.
“Given that there are clear alternatives for most patients,
the fact that 21% of elderly people were prescribed these inappropriate drugs
is very troubling,” senior researcher Kevin A. Schulman, MD, tells WebMD.
“This is an important component of (multiple drug interaction problems) in
the elderly and it clearly needs a lot more attention than we have been giving
it.”
Mood-Altering Drugs Top the List
People over the age of 65 make up less than 15% of the U.S.
population, but they account for nearly one-third of the drug prescriptions.
The elderly are far more likely than younger people to take multiple
prescription medications, and they are also more likely to have adverse
reactions to drugs due to age-related changes in metabolism and kidney
function.
With this in mind, a list of prescription medications
considered inappropriate for use by nursing home residents was developed in the
early 1990s and later revised to include all elderly people. Known as the Beers
list, the guide includes 28 medications or classes of drugs that should be
avoided in elderly people.
Many of the drugs included on the Beers list may cause problems
with thinking and alertness, particularly in elderly people. In addition to the
fact that these drugs are more likely to interfere with other drugs that
elderly people are likely taking, these sedating drugs may also increase the
risk of falling. Falling, which often leads to serious accidents, such as a
broken hip, are a large cause of injury and even death in the elderly.
Drugs on the list are more likely to cause mood changes or
drowsiness and include:
Mood-Altering Drugs

Elavil (amitriptyline)
Librium (chlordiazepoxide)
Valium (diazepam)
Adapin and Sinequan (doxepin)
Dalmane (flurazepam)
Atarax (hydroxyzine)
Meprobomate (a barbiturate similar to phenobarbital)

Muscle Relaxers

Soma (carisoprodol)
Parafon Forte (chlorzoxazone)
Flexeril (cyclobenzaprine)
Skelaxin (metaxalone)
Robaxin (methocarbamol)

In this study, Duke researchers reviewed prescription drug
claims during 1999 for more than 765,000 people aged 65 and over enrolled in a
major medication benefits group. Twenty-one percent filled prescriptions for
drugs on the Beers list, and 4% of these patients filled prescriptions for
three or more of the drugs.
The two most widely prescribed Beers drugs were the
psychotropic drugs Elavil and Adapin, which accounted for just over half of the
claims for drugs on the list with potentially severe adverse side effects.
These drugs are commonly given at low doses to help elderly people sleep.
The study findings are reported in the Aug. 9/23 issue of the
Archives of Internal Medicine.
“Most of the drugs on this list have fallen out of favor
for use in general because there are newer and safer alternatives,”
American Geriatric Society spokesman Todd Semla, PharmD, tells WebMD. “The
longer-acting psychotropic drugs are especially risky for older people because
the risk of adverse events like hip fractures from falls is so great.”

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