Prescribing Potentially Inappropriate Medications to Older Adults Is Common, Costly
Key findings
- This cross-sectional study estimated the extent and cost of potentially inappropriate prescribing of medications to older adults in the U.S. between 2014 and 2018
- Researchers compared the Medicare Part D Prescription Drug Program data set for 2014–2018 with the American Geriatrics Society Beers Criteria, a resource for identifying medications that are potentially inappropriate for adults older than age 65
- By number of doses, the potentially inappropriate medications most commonly dispensed in 2018 were proton pump inhibitors (45%), benzodiazepines (31%) and tricyclic antidepressants (9%)
- Between 2014 and 2018, 43 billion doses of potentially inappropriate medications were dispensed, with spending of $25.2 billion
- Careful attention to the Beers Criteria and stopping medication when appropriate are important opportunities to reduce costs and improve outcomes among older adults
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Older age is one of the strongest risk factors for adverse effects of medications, partly because of high rates of polypharmacy and comorbidities. The American Geriatrics Society has developed the Beers Criteria, a resource for identifying medications that are potentially inappropriate for adults older than age 65. These evidence-based guidelines are updated every three years by an interdisciplinary panel.
Using Medicare data, Chana A. Sacks, MD, MPH, physician in the Division of General Internal Medicine, and Christine Seel Ritchie, MD, MSPH, director of research in the Division of Palliative Care and Geriatric Medicine and director of the Mongan Institute Center for Aging and Serious Illness, of Massachusetts General Hospital, and colleagues have determined that billions of doses of potentially inappropriate medications are dispensed to older patients in the U.S. every year. Their report appears in the Journal of the American Geriatrics Society.
Study Details
The researchers used the Medicare Part D Prescription Drug Program data set for 2014–2018, which represents about 70% of Medicare beneficiaries. They searched for information about prescribing of medications that carry a strong recommendation in the Beers Criteria as being inappropriate for older patients:
- Benzodiazepines
- Sulfonylureas
- Proton pump inhibitors
- Tricyclic antidepressants
- Antiarrhythmics
- Estrogen-containing medications
- Somatotropin
- Barbiturates
Results
In 2018, 7.3 billion doses of potentially inappropriate medications were dispensed to patients enrolled in Medicare Part D. By numbers of doses, the potentially inappropriate medications most commonly dispensed in 2018 were proton pump inhibitors (45%), benzodiazepines (31%) and tricyclics (9%), which together accounted for $4.4 billion in spending in 2018. By spending, the top five potentially inappropriate medications dispensed in 2018 were dexlansoprazole ($602 million), esomeprazole ($506 million), omeprazole ($390 million), dronedarone ($313 million) and conjugated estrogens ($298 million). And, between 2014 and 2018, 43 billion doses of potentially inappropriate medications were dispensed, with spending of $25.2 billion.
Opportunities to Improve Care
Potentially inappropriate prescribing for older adults is worrisome because of the increased risk of delirium, falls, hip fracture and/or hospitalization. Careful attention to the Beers Criteria and deprescribing when appropriate are important opportunities to reduce costs and potentially improve outcomes among older adults.
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