Elderly Patients Prescribed Inappropriate Medications at 8 Percent of Doctor Visits

For Release: February 9, 2004

Contact: NCHS/CDC Public Affairs, (301) 458-4800

Inappropriate Medication Prescribing for Elderly Ambulatory Care Patients, Archives of Internal Medicine. Journal of the American Medical Association, Volume 164. February 9, 2004.

Elderly patients were prescribed inappropriate medications at almost 8 percent of doctor visits in 2000, about the same percent as 1995, according to a new study of drug prescribing patterns published in the February 9 issue of Archives of Internal Medicine.

The study, based on data from the Centers for Disease Control (CDC) surveys of ambulatory medical care providers, showed that inappropriate medicines were prescribed at almost 8 percent of doctor visits made by patients age 65 and older. Inappropriate medications were defined as those that had a risk of adverse outcomes outweighing the potential benefits for most elderly patients.

The article identified a small number of drugs including certain pain relievers, antianxiety agents, antidepressants and sedatives as posing a large share of the problem. In 2000, the inappropriate drugs most frequently prescribed at doctor visits made by the elderly were the pain reliever propoxyphene, the antihistamine hydroxyzine, the antianxiety agent diazepam, the antidepressant amitriptyline, and the urinary tract relaxant oxybutynin.

The likelihood that an inappropriate drug was prescribed was higher when multiple medications were prescribed and double at doctor visits when the patients were women. The likelihood of inappropriate medications being prescribed was higher for patients ages 65 to 79 than for patients age 80 and older, but the study found no difference by patient’s race. Nor was there any difference by geographic region of the country.

A panel of geriatric medicine and pharmacology experts used published evidence on specific drugs and clinical experience to identify 38 drugs or drug groups as generally inappropriate for patients older than age 65. The study applied that list to the drug information reported in the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey conducted by CDC’s National Center for Health Statistics. The surveys capture information on drugs ordered or prescribed at visits to doctors in office-based practices and in hospital outpatient departments. Since the outcomes of use of these inappropriate medications are not measured in the survey, they may be said to define potential, rather than actual, inappropriate prescribing.

In 2000, seniors made over 200 million visits to the doctor either in private offices or hospital outpatient clinics. No drugs were prescribed in about a third of the visits; in another third, one or two drugs were prescribed; and for the remaining third, three or more drugs were prescribed.

The full study is available at http://www.jamamedia.org or call 312-464-5262. For more information about the surveys, visit the CDC/NCHS Website.