1 in 2 older Americans use prescription drugs and over-the-counter products together. 4% of them are at-risk of adverse drug interaction.

The potential for adverse reactions is substantial; nearly 30% of older adults take at least 5 Rx medications on a regular basis. Older people are the biggest consumers of prescription meds and thus are more at-risk for adverse events in combining these drugs with other drugs, and with OTCs and supplements.

These warnings come out of a study that will be published in the 24/31 December issue of JAMA. The researchers analyzed drug/OTC use among adults 57 years of age and older between June 2005 and March 2006.

The use of Rxs among older Americans has increased in recent years, due to several factors: the emergence of available therapies for chronic diseases like diabetes and heart disease; and, access to drugs through the Medicare Part D programs and patient assistance programs.

As the growing use of meds has increased, so, too, has adoption of OTCs, vitamins, minerals and supplements. Examples of more common supplement use include red rice yeast as a statin replacement and fish oil targeting cardiovascular health.

Nearly all older Americans age 57 and over regularly use at least 1 prescription drug; 2 in 3 older Americans use Rx drugs and OTCs/supplements concurrently.

Health Populi’s Hot Points: Self-care, and especially consumer adoption of OTC meds, will continue to grow during the recession as people look to project-manage their personal health within tight household budgets.

“Despite concerns about drug safety and new federal policies to improve older adults’ access to medications, current information on their concurrent [regular use of at least 2 medications] use of prescription medications, over-the-counter medications, and dietary supplements is limited,” the researchers contend.

Overall, drug reactions send 700,000 people to the ER annually — a rate of 2.4 per 1000 — according to a study published in the Journal of the American Medical Association in 2006. The chart shown above comes from that study.

As the above chart clearly illustrates, there is a direct relationship between age and adverse drugs events. Individuals aged 65 years or older were more than twice as likely to be treated in emergency for an adverse drug event — and nearly 7x as likely to require hospitalization as people under 65.

A dynamic duo of clinicians at Tufts, Dr. Cung Pham and Dr. Robert Dickman, have offered some sage advice on how to prevent adverse drug events among older people:

  • Avoid misuse of medications by consulting with the Beers Criteria, a list of drugs that IDs medications as potentially inappropriate for older people, and older people with particular conditions;
  • Avoid overuse of medications by carefully reviewing drug-drug interactions and dosing; and,
  • Avoid underuse of medication, and ensuring adherence to prescribed instructions.

A patient’s self-packed “brown bag” of medications shared with a clinician who makes a complete list of them — whether in an EMR or on a piece of paper to be kept in the patient’s chart as well as by the patient and a caregiver/advocate — is a very useful tool.

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