Careless Prescribing Puts Elders At Risk

Doctors know better than to prescribe certain dangerous drugs to pregnant women. Medications like thalidomide (Thalomid) or isotretinon (Accutane) can cause tragic birth defects. The ulcer medicine misoprostol (Cytotec) can trigger premature labor.
Packaging and prescribing instructions for these drugs make it clear that they are forbidden during pregnancy. Safeguards can make it difficult for a doctor to prescribe them without realizing the hazards.
But there is another list, targeting a different group of vulnerable patients. Many doctors don’t know anything about it. The Beers list spells out dozens of medicines that may cause serious side effects in elderly patients.
An expert panel determined, for example, that pain relievers like meperidine (Demerol) and pentazocine (Talwin) carry more risk than benefit for the elderly. The sleeping pill flurazepam (Dalmane) produces sedation that lasts too long increasing the risk of falls. For the most part, doctors should avoid prescribing such drugs for older people.
Unfortunately, a new study in the Archives of Internal Medicine (Aug 9/23, 2004) shows that the list has not been put into practice. Researchers analyzed an enormous national database with the prescriptions of more than 750,000 senior citizens.
Approximately 20 percent of the patients got prescriptions for at least one drug that caused the researchers concern, and 15 percent received prescriptions for two drugs on the suspect list.
What is especially alarming about the results of this new study is that they so closely mirror similar findings from research from 1987, 1996 and 1999. In other words, despite repeated warnings to physicians and pharmacists about inappropriate prescribing and dispensing, the problem continues. Perhaps even worse, the authors suggest that their study may underestimate the problem.
Drugs on the Beers list do not carry special warnings on their labels as drugs that cause birth defects do. Medical education does not adequately emphasize the special problems older people face with many prescription drugs.
It is not obvious why seniors get such poor treatment. Imagine the outcry if physicians prescribed dangerous drugs to one out of five pregnant women. But there is no sense of outrage when it comes to misprescribing to older folks. And health policy leaders have not given priority to this serious health care crisis.
Until physicians and pharmacists put systems in place to protect their older patients adequately, what can a family do? Loved ones need to be especially vigilant whenever someone over the age of 65 is given a prescription.
We have prepared a Guide to Drugs and Older People with a list of potentially dangerous drugs and a safety check list. Anyone who would like a copy, please send $2 in check or money order with a long (no. 10) stamped (60 cents), self-addressed envelope: Graedons’ People’s Pharmacy, No. O-85, P. O. Box 52027, Durham, NC 27717-2027.
The moral of this research is that older Americans, who take more medicines than the rest of the population, remain at risk of receiving inappropriate prescription drugs. It’s time we stopped accepting this sad fact and started demanding better care for seniors.