Seniors still taking too many potentially inappropriate medications: report

Seniors are still taking too many potentially inappropriate medications, according to a new study published by the Research Institute of the McGill University Health Centre (MUHC).

According to the report, these drugs could do more harm than good and may be ineffective for elderly patients.

“Although spending on (potentially inappropriate medications, or PIMs) has declined in Canada, the overall cost remains high,” reads the study. “Harmful PIM prescriptions have increased, and targeted and scalable interventions are needed.”

Dr. Emily McDonald and colleagues discovered that, despite some improvements since 2013, prescriptions of potentially inappropriate medications remain very common among Canadian seniors, with 42 per cent of Canadians over the age of 65 taking at least one PMI in 2021.

However, the situation is not all negative. For example, while the population of those aged 65 and over increased by 32 per cent between 2013 and 2021 in Canada, total spending on PIMs for seniors decreased by 33.6 per cent, from $1.5 billion to $1 billion.

Quarterly spending on seniors also decreased from $95 to $57.

Total spending on PMIs decreased in all categories between 2013 and 2021, except for gabapentinoids (a jump of 36.4 per cent) and antipsychotics (a rise of 7.2 per cent).

The authors point out that a drug price reduction, rather than a prescription decline is responsible for most of the savings.

Gabapentinoids are anticonvulsant agents that are commonly used to treat neuropathic pain.

Despite an increased risk of adverse effects and even death, particularly when taken in combination with opioids, gabapentinoids are among the 10 most prescribed drugs in North America and are reportedly prescribed inappropriately in 83 per cent of cases.

“Off-label use of gabapentinoids” is recognized as a major problem in North America, and escalating trends in misuse and abuse are “contributing to harm,” the authors wrote.

“This class of drugs has been tried to treat different types of pain, but studies show that it doesn’t work very well, and in fact it greatly increases the risk of complications and side effects,” said Dr. McDonald.

PIM prescriptions stem partly from the lack of pharmaceutical options for certain conditions, but also from difficult or expensive access to non-pharmaceutical options, like physiotherapist services.

Additionally, for a doctor who only has a few minutes to spend with a patient, it may be quicker to write a prescription than to take the time to explain how the medication is not appropriate and could cause side effects, McDonald added.

“It’s a very complex problem,” she said.

Beyond the financial cost of prescriptions, the use of these drugs carries an excessive risk of adverse events, such as falls, fractures, cognitive impairment, and death. Their usage creates pressure on the health system, contributing to the increase in emergency room visits and hospitalizations.

The authors’ calculations are based on data from the National Prescription Drug Utilization Information System. They also used Statistics Canada’s Consumer Price Index to account for inflation between 2013 and 2021.

The findings of this study were published by the Journal of the American Geriatrics Society.

–This report by La Presse Canadienne was translated by CityNews