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One in Five Seniors Found Taking High Risk Medications

White pills in a prescription bottle (


A study by public health researchers at Brown University in Providence finds about one in five older citizens in the U.S. are taking medications considered potentially harmful to people in that age group. Danya Qato, a practicing pharmacist and doctoral candidate, with Amal Trivedi, a general internist and health services researcher at Brown, published their findings in this month’s issue of the Journal of General Internal Medicine (paid subscription required).

Qato and Trivedi analyzed data from more than 6,200,000 enrollees in Medicare Advantage plans, also known as Medicare Part C, during 2009 that combine traditional Medicare hospital and doctor coverage (Medicare parts A and B) with services offered by health insurance companies, such as health maintenance organizations or medical savings accounts. Some Medicare Advantage plans also include drug coverage, usually provided separately under Medicare Part D.

The records used in the analysis came from the Healthcare Effectiveness Data and Information Set, a widely used set of performance measures compiled and published by National Committee for Quality Assurance, consisting of 75 indicators across eight domains of care. One of those indicators is Drugs to be Avoided in the Elderly or DAE, a list of medications considered to put the patient at high-risk for adverse drug events.

Qato and Trivedi found 21 percent of Medicare Advantage members — more than 1.3 million people — received at least one high-risk medication in 2009, with nearly 5 percent receiving two of these drugs. Demographic breakdowns of the results show the chance of older Americans receiving high-risk medications rises if they are lower income, women, and living in southern states.

The researchers report the geographic differences were particularly noticeable. Residents of southern states from Texas to South Carolina had a 10 to 12 percentage point higher risk of receiving potentially harmful prescriptions than people in New England. Albany, Georgia had the highest rate of people receiving one high-risk prescriptions: 38 percent. Some 13.5 percent of older residents of Alexandria, Louisiana received two high-risk prescriptions.

Older citizens in Mason City, Iowa had the lowest rate of getting a single high-risk medication (9.6%), while less than 1 percent (0.7%) of older residents of Worcester, Massachusetts received two high-risk prescriptions. Women were 10 percentage points more likely to receive a high-risk  medication, while older people in lower socio-economic regions had a nearly 3 percentage point greater chance of getting a high-risk prescription than those in the richest areas.

Qato and Trivedi attribute the gender differences to the inclusion on the list of those medications that treat ailments specific to women or that are more common in women. And while the differences in socio-economic status are smaller than for gender or geography, those differences may be due to economically poorer areas having less access to high-quality health care.

Geographic differences, say the researchers, may be the result more complex and interacting factors. Those variables could include higher patient demand for the drugs, a higher prevalence of chronic medical problems in the region, inadequate medical training in prescriptions for elderly patients, or perhaps a different prescribing culture. Qato and Trivedi point out that socio-economic differences alone do not explain the geographic disparities.

One way to reduce the number of high-risk prescriptions, notes Qato, is for older citizens to take greater ownership of their health care and to be more vigilant about their prescription drug use. “This is one of the many reminders for patients to regularly review the appropriateness and safety of their medications with their pharmacist and physician,” says Qato. “Patients are often their own best advocates.”

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