A challenge in maintaining a proper balance of prescription medications in elderly adults has been thrown into sharp focus with the results of a Belgian study suggesting that only 17% of seniors are receiving the right level of medication. The remaining 83% were either subject to prescription misuse (being prescribed the wrong drug) or underuse (being prescribed too little of a drug).
The study monitored 503 community-dwelling, elderly adults aged 80 or over for a period of 18 months. Of these patients, 58% were taking five or more medications for chronic health problems each day. Instances of underuse were observed in 67% of patients and misuse was seen in 56% of patients, with the two groups having some overlap. Only the above-mentioned 17% of patients, or about 85 patients, were both prescribed the right types of medicine and the right amounts.
During the 18 month period, each underused medication was associated with a 39% greater chance of death and a 26% increased chance of hospitalization. Misuse, to the researcher’s surprise, did not have a clear link to either outcome.
Proper prescribing for elderly patients is often harder compared to non-senior adults. This is because elderly adults are more likely to have multiple health conditions requiring prescription medications and their bodies are also more sensitive to the effects and side effects of drugs. This raises the health risks from both single-drug side effects and unwanted drug interactions.
The study authors suggest that prescribers make use of clinical pharmacologists for consulting on prescription medications for elderly adults since this can make it easier to understand when a prescription misuse or underuse is likely to occur. A stronger focus on evidence-based medicine as opposed to prescriptions being done by habit or rote may also help.
Figures for prescription overuse were not covered in the study, which was published in the British Journal of Clinical Pharmacology.
Wauters, M., et. al., “Too many, too few, or too unsafe? Impact of inappropriate prescribing on mortality, and hospitalisation in a cohort of community-dwelling oldest old,” British Journal of Clinical Pharmacology, 2016; 10.1111/bcp.13055.