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Many adults over the age of 65 take multiple medications. Sometimes taking several drugs at the same time can cause problems. Sometimes physicians unknowingly prescribe medications that can be ineffective or unnecessary.

New Research in the Journal of the American Geriatrics Society

In order to determine how common medication problems are among older patients, researchers studied data collected during 2001-2003 at the Iowa City Veterans Affairs Medical Center. The study enrolled veterans age 65 and older who were using 5 or more medications.

The researchers analyzed a total of 1,582 medications taken by 196 patients. They assessed whether:

• Any of the medications was prescribed inappropriately (These drugs should be eliminated without substitution)
• If there were better and safer drugs that should have been prescribed.
• If any patients were taking drugs that were specifically not recommended for use by elders.
• If there was any medication underuse (for example, the patient needed a specific drug but was not receiving it).

194 men and 2 women participated in the study, The average age of the study subject was 74.6 and they took an average of 8.1 medications, including an average of 1.4 over-the-counter medications. Thirty-two percent of the patients used 6 or fewer drugs, 43% used 7 to 9 drugs, and 25% used 10 or more drugs. This study did not include vitamins and minerals, herbal medications, medications applied to the skin, or medications taken on an as-needed basis.

Of the 196 patients in the study:

• 128 patients (65%) were taking one or more inappropriate medications. This included:
• 112 patients (57%) were taking medications that were ineffective, not indicated for their illness or condition, or duplicated a medicine they were already taking
• 73 patients (37%) were taking medications that should not be given to older adults
• (The numbers above do not add to 65% because some patients had both types of medication problems)

The use of inappropriate medications increased with increases in the total number of medications taken. For example, patients who took 10 or more medications were taking an average of nearly 2 wrong medications. In contrast, regardless of the number of medications taken, there was an average of 1 underused drug per patient in the study. The researchers also found that approximately half of the underused drugs were medications used to treat various heart and circulatory system conditions such as heart attacks, high blood pressure, and high cholesterol.

What Should I Do?

This study shows the importance of reviewing a list of all medications at each visit with the health care provider. The list should include vitamins, supplements, and all other over-the-counter medicines and preparations. This is especially important for older patients taking multiple medications.

For more information on drug treatment and drug interactions, visit Aging in the Know.

The summary above is from the full report entitled "Polypharmacy and Prescribing Quality in Elders." It is in the October 2006 issue of the Journal of the American Geriatrics Society (Volume 54, Issue 10). The report is authored by Michael A. Steinman, MD; C. Seth Landefeld, MD; Gary E. Rosenthal, MD; Daniel Berthenthal, MPH; Saunak Sen, PhD; and Peter J. Kaboli, MD, MS.