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Two studies raise concerns about the overprescribing of prescription drugs to older Americans

REUTERS/Jim Young
Nearly half — 45.9 percent — of the older people who had been prescribed three or more psychotropic drugs by their doctors had no indication in their medical records that they had been formally diagnosed with a mental health condition, insomnia or a pain condition.

Two recent studies underscore how current medical practices are resulting in the overprescribing of prescription drugs to retirement-aged Americans, with potentially deadly results.

One study reports that large numbers of Medicare patients are being prescribed multiple psychotropic drugs — medications that affect how the brain functions and that are typically used for treating mental health or pain conditions — even though most of those patients have never been diagnosed with such a condition.

The other study found a wide variation among emergency room doctors in their rates of prescribing opioids to older patients. It also found that patients of the high-prescribing doctors were much more likely to then become chronic users of the powerful drugs.

Both studies raise serious questions about the quality of medical care received by older Americans. Dizziness, confusion and other common side effects of psychotropic drugs tend to be more pronounced in the elderly. And the long-term effects of opioids include constipation, sleep-related breathing problems, bone fractures (from falls and other injuries) and addiction. 

The overprescribing of these drugs, therefore, puts older people at greater risk of experiencing a serious deterioration of their quality of life.

It also increases their risk of premature death.

First study

For the first study, which was published in JAMA Internal Medicine, researchers examined annual government data on visits to doctors by patients aged 65 and older from 2004 through 2013. They looked specifically at visits that resulted in the prescribing of at least three psychotropic medications — drugs such as tranquilizers, antidepressants, sleep aids and opioid painkillers.

The researchers found that the number of such visits increased by almost 150 percent during the 10-year period of the study, from 1.5 million in 2004 (or 0.6 percent of all doctor visits) to 3.68 million in 2013 (1.4 percent of all doctor visits). The increase was especially pronounced in rural areas of the country.

“The rise we saw in these data may reflect the increased willingness of seniors to seek help and accept medication for mental health conditions — but it’s also concerning because of the risks of combining these medications,” said Dr. Donovan Maust, the study’s lead author and a geriatric psychiatrist at the University of Michigan, in a released statement.

Perhaps the most stunning finding of the study, however, was that nearly half — 45.9 percent — of the older people who had been prescribed three or more psychotropic drugs by their doctors had no indication in their medical records that they had been formally diagnosed with a mental health condition, insomnia or a pain condition.

“We hope that the newer prescribing guidelines for older adults encourage providers and patients to reconsider the potential risks and benefits from these combinations,” said Maust in the released statement.

In a comment to New York Times reporter Benedict Carey, Maust was a bit less sanguine about the prescription trends uncovered in his study: “This is a particularly worrisome pattern,” he said, “and suggests some inappropriate prescribing.”

Second study

For the second study, which was published in the New England Journal of Medicine, researchers examined the prescribing habits of about 14,000 hospital emergency doctors who had treated almost 400,000 Medicare patients from 2008 through 2011. None of the patients had received a prescription for opioids within the six months prior to showing up at the emergency department.

The researchers separated the doctors into four groups based on the number of opioid prescriptions they had written for these Medicare patients. They found wide variations in the doctors’ prescribing patterns, even within the same hospitals.

The opioid prescription rate of those who prescribed the drugs the most (24.1 percent of the time) was more than three times higher than that of those who prescribed them the least (7.3 percent of the time). This was true even though both groups of doctors saw patients with similar characteristics, including the medical conditions for which the patients had come to the emergency room.

The researchers’ analysis also revealed this disturbing finding: During a 12-month period following their emergency department visit, the patients seen by the high-prescribing physicians were 30 percent more likely to develop long-term opioid use than those seen by the low-prescribing physicians.

“These results suggest that an increased likelihood of receiving an opioid for even one encounter could drive clinically significant future long-term opioid use and potentially increased adverse outcomes among the elderly,” study’s authors conclude.

Of course, this study was observational, so it can’t prove that any patient’s long-term use of opioids was triggered by a single emergency room visit. 

Still, as the authors point out in their paper, “if our results represent a causal relationship, for every 48 patients prescribed a new opioid in the emergency department who might not otherwise use opioids, 1 will become a long-term user.”

“This is a low number needed to harm for such a common therapy,” they add.

FMI: You can read the studies on the websites for JAMA Internal Medicine and the New England Journal of Medicine.

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