Medication use in seniors: challenges and solutions.
Use of prescribed and over-the-counter medication increases with age. Although drug therapy often results in beneficial effects and improve functional status, drug related illness is a significant health problem, accounting for 5 to 23 per cent of hospitalization, 1.75 per cent of ambulatory visits and one in 1000 deaths. In most studies, drug-related illness is more common in the elderly. Four factors influence the likelihood that a patient will experience adverse effects from a drug: the type of drug prescribed, the characteristics of patients receiving the drug, the characteristics of physicians who are prescribing the medication, and health care system policy and practice. Cardiovascular drugs, psychotropic drugs and NSAIDs are the three groups of drugs that are most commonly implicated in drug related illness, probably because they are the three groups of drugs that are most commonly prescribed in the elderly. The risk of an adverse effect with drug increases with the number of drugs prescribed. Several mechanisms may account for this phenomenon including (1) increased sensitivity of diseased tissue to drug toxicity (2) potential drug interactions, and (3) difficulties in patient compliance with an increasing number of drugs. Physician prescribing habits can increase the risk of adverse drug effects through two mechanisms: (1) the prescription of drugs that are unnecessary for the treatment of ailments that might be better managed through non-pharmacologic management and (2) the inappropriate prescription of drugs that are either contraindicated or prescribed in combination with other drugs that produce potential drug interaction. Errors in prescribing accounting for 19 to 36 per cent of hospital admissions due to drug-related events and up to 72 per cent of drug related events occurring in the hospital setting. Health care system policies influence the list of drugs that are included in the formulary, the conditions under which they are accessible and payment policy, all of which strongly influence the likelihood that a drug will be utilized. Physician payment policy may also influence drug prescribing and the success of initiatives to discontinue drugs. Interventions to improve the optimal use of medication will need to target policy, patients and physicians. Better information needs to be provided to physicians and patients about the risks and benefits of drug therapy, and the problems of patient compliance and inappropriate and unnecessary prescribing need to be addressed.
Tamblyn
R
R
Division of Clinical Epidemiology, Health Services and Outcomes Research Group, Montreal, Quebec.
D000368:Aged; D000369:Aged, 80 and over; D003695:Delivery of Health Care; D004347:Drug Interactions; D011307:Drug Prescriptions; D004359:Drug Therapy, Combination; D004363:Drug Utilization; D017048:Health Care Costs; D006291:Health Policy; D006801:Humans; D009017:Morbidity; D012307:Risk Factors; D012651:Self Medication / Q000009:adverse effects* / Q000706:statistics & numerical data