Up To One in Five Elderly Prescribed Potentially Inappropriate Medications
Remarks of FB in brackets within > http://www.ahrq.gov/news/press/pr2001/prescrip.htm > > Up To One in Five Elderly Prescribed Potentially Inappropriate Medications > > Press Release Date: December 11, 2001 > > A new study from the U.S. Agency for Healthcare Research and Quality (AHRQ) > highlights the problem of inappropriate prescribing in elderly patients in > the United States. The study also underscores the importance of safe use of > prescription medications as a critical component of quality of care, and > demonstrates the challenges involved in assessing safe use. > > According to findings in today's Journal of the American Medical > Association, about one-fifth of the approximately 32 million elderly > Americans not living in nursing homes in 1996 used at least one or more of > 33 prescription medicines considered potentially inappropriate. Nearly one > million elderly used at least one of 11 medications which a panel of > geriatric medicine and pharmacy experts advising the researchers agreed > should always be avoided in the elderly. These 11 medications include > long-acting benzodiazapines, sedative or hypnotic agents, long-acting oral > hypoglycemics, analgesics, antiemetics and gastrointestinal antispasmodics.
[Fred A. Baughman Jr., MD:
virtually all psychotropic drugs, all of them known to cause brain
dysfunction on the short-term, brain-damage on the long-term, should be
avoided
in the elderly and deemed inappropriate.
]
> AHRQ Director John M. Eisenberg, M.D., said, "This important research > indicates that patient safety issues can occur outside hospitals, nursing > homes, and institutional settings and among any patient population. This > study highlights the need to develop evidence-based programs and ways to > improve prescribing practices in the United States."
[Fred A. Baughman Jr., MD:
"Evidence-based" is the new buzz-word. This would be fine were the new
"evidenced based," peer-reviewed literature, not controlled by the
pharmaceutical industry and an industry-controlled medical academia.
Prescribing practices will not become appropriate as long as the US
physician
glut is maintained, and worsened, leaving fewer patients and less real
disease
all the time for every physician, literally forcing them to contrive things
to
prescribe and even invent diseases to prescribe for where none exist. In
the US
the physician corps has grown from 145/100,000 (physicians/ 100,000
citizens) in
1965 to 290/100,000 today, leaving each physician with 1/2 the new patients
and
half the real disease today that they encountered in 1965. This is why we
spend
nearly twice as much on diagnosis and treatment per patient in the US than
in
any other country in the world. Consider that the ADHD epidemic in the US
having reached 6-7 million, costing 50 billion or more per year is a total
fraud, a contrivance, taking much needed health care dollars from persons
with
real, actual illnesses. Physicians and the pharmaceutical industry take
their
services, not necessarily where the are truly needed, but where the dollars
are--where the marketplace dictates.
]
> > The study also suggests that elderly women and older people who are in poor > health and who use more prescriptions are more likely than others to receive > inappropriate drugs.
[Fred A. Baughman Jr., MD:
The elderly and the otherwise disenfrancised and powerless undoubtedly
get
more unnecessary diagnostic and therapeutic services of all kinds, all of
them
profit-seeking, not health-seeking.
]
> According to lead author, Chunliu Zhan, M.D., Ph.D., the actual extent of > inappropriate medication prescribing may be much higher than the estimates > because of the conservative criteria the researchers used and because of the > rate of introduction of new pharmaceutical agents into the market. > Furthermore, inappropriate medication use in the elderly is a component of > the even larger problem of suboptimal prescribing, which includes under-use > of effective medications, inappropriate dosing, inappropriate combination > use of drugs, and other prescription errors.
[Fred A. Baughman Jr., MD:
where doctors prescribe new, expensive, effectively marketed
medications to
the exclusion of older, tried and true drugs, drugs with which physicians
are
experience and familiar, patients (the public, all patients at one time or
another) are undoubtedly put at higher risk. How high a risk is rarely
known
due to the short duration of most clinical trial. Most significant side
effects
only become known in the years of clinical experience following marketing of
new
drugs.
]
>
> The full list of 33 potentially inappropriate medications reflects the
> consensus of the expert panel. Not all physicians agree about the
> appropriateness of specific drugs for the elderly. This lack of consensus
> stems in part from the limited amount of evidence of risks and benefits for
> some medications because older patients are often excluded from drug
> clinical trials due to their and other medical problems.
>
> The estimates are the most recent to use population-based nationally
> representative survey data. The study was based on AHRQ Medical Expenditure
> Panel Survey data on a national sample of 2,455 community dwelling elderly
> persons aged 65 and older in 1996.
>
> AHRQ and its parent, the Department of Health and Human Services (HHS), are
> committed to improving the quality and safety of health care for all
> Americans and support research and other efforts to reduce inappropriate
> prescribing. For instance, AHRQ is sponsoring research on new technologies,
> such as hand-held computers, to reduce prescribing errors as part of its $50
> million patient safety research agenda. In addition, AHRQ-supported Centers
> for Education and Research on Therapeutics are working to increase awareness
> of the benefits and risks of new uses or combinations of medical products,
> as well as improving the effectiveness of existing uses. In March 2001, HHS
> Secretary Tommy G. Thomson created an HHS Patient Safety Task Force to
> better coordinate efforts to collect and report information about patient
> safety. More information on HHS' patient safety efforts is available at
> http://www.hhs.gov/news/press/2001pres/01fsMedErrors.html
>
> For further details about the study, see "Potentially Inappropriate
> Medication Use in the Community-Dwelling Elderly: Findings from the 1996
> Medical Expenditure Panel Survey," by Drs. Zhan, Sangl, Bierman, Miller,
> Wickizer and Meyer of AHRQ, and Bruce Friedman, Ph.D., of the University of
> Rochester. Findings are in the December 12, 2001 issue of the Journal of the
> American Medical Association.
>
> For additional information, please contact AHRQ Public Affairs, (301)
> 594-1364: Karen Migdail, (301) 594-6120 (KMigdail@ahrq.gov); Bob Isquith,
> (301) 594-6394 (RIsquith@ahrq.gov).
>
> Internet Citation:
>
> Up To One in Five Elderly Prescribed Potentially Inappropriate Medications.
> Press Release, December 11, 2001. Agency for Healthcare Research and
> Quality, Rockville, MD. http://www.ahrq.gov/news/press/pr2001/prescrip.htm
>
> "The limits of tyrants are prescribed by the endurance of those whom they
> oppress."
>
> Frederick Douglas
> {1817-1895 Slave, Abolitionist & Political Reformer}