Jan. 28, 2008 For many elderly Americans, the day begins and ends with a dose of one or more prescription medications. However, some patients could be less likely to receive the wrong dosage or type of medications than others are, according to a recent study of more than 800,000 U.S. seniors.
“Patients who received care from a geriatrician tend to have better prescribing and they tend not to receive drugs that are inappropriate for older patients,” said Mary Jo Pugh, Ph.D., the study’s lead author.
That is because geriatricians are trained to “take a much closer look at the medications than the average physician does, and their assessment is focused on how medications may affect patients differently as they age,” she said.
Pugh, a registered nurse and research scientist at South Texas Veterans Health Care System in San Antonio, and colleagues used Veterans Administration (VA) pharmacy and patient care records to identify instances of inappropriate prescribing among 850,154 patients who received care at 124 VA facilities during 1999 and 2000.
The results showed that, overall, 26.2 percent of elderly patients were given drugs identified as inappropriate or suboptimal for older patients.
However, older veterans who had received geriatric care in the last year proved less likely to receive inappropriate prescriptions, compared to similar patients who had not received geriatric care. In this study, only 3 percent of patients received geriatric care in the last year.
“The population of elderly adults in the United States is rapidly growing, as is the number of medications that older adults use on a regular basis. So, older adults are at increasing risk of experiencing adverse drug events,” said Alex Federman, M.D., assistant professor of medicine at Mount Sinai School of Medicine in New York City.
“This study strongly suggests that geriatricians have an important role in the safe prescription of medications of older adults,” said Federman, who did not participate in the research.
However, he added that “geriatric care may have a bigger impact on the reduction of inappropriate medication use among older adults in the VA health care system than outside of it,” due to the electronic medical record and prescribing system available within the VA.
“Such a system might also help diffuse knowledge about appropriate prescribing for seniors, which would affect the investigators’ findings,” Federman said.
To help reduce the risk of complications arising from the use of prescription medications, “seniors should make sure that they have a good primary care doctor, and a geriatrician may be a particularly good choice for some older adults, especially those with multiple chronic diseases and complex healthcare management needs,” Federman said.
The Veterans Administration Health Services Research and Development Service funded the study.
Journal reference: Pugh MJV, et al. Potentially inappropriate prescribing for the elderly: effects of geriatric care at the patient and health care system level. Medical Care 46(2), 2008.
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