More than half of older adults use at least one psychoactive medication, study says

Older adults are taking more psychoactive medications than they did in years past, according to researchers who wanted to find out how prevalent psychoactive medication use is in this patient population.

“These numbers are significantly higher than previous reports from 1996 for all subclasses of psychoactive medications studied, except tricyclic antidepressants,” said lead author Yara Haddad, PharmD, MPH, BCGP, who is with CDC.

The 2013 study findings were compared to numbers from a 1996 study using the same dataset. Recent studies estimating the national prevalence of psychoactive medication use in older adults have been limited.

The findings, which were published in the September–October 2019 issue of the Journal of the American Pharmacists Association (JAPhA), showed that anticonvulsant use increased 450% for older community-dwelling Americans, SSRI use increased 300%, opioid use increased 140%, and benzodiazepine use increased 50% from 1996 to 2013.

The research team found that overall, more than one-half of older adults used at least one psychoactive medication in 2013, and about 1 in 10 older adults used three or more psychoactive medications.

The American Geriatric Society’s Beers Criteria recommend avoiding use of psychoactive medication in older adults at risk of falls. “We know that older adult falls are common, with one in four adults aged 65 and older reporting a fall each year,” said Haddad. “We also know that prescription medication use and polypharmacy in older adults have increased over the past decade. Medication use in older adults, specifically psychoactive medication, is one of the modifiable risk factors that can be targeted to lower the risk of falls.”

Kelly Lee, PharmD, BCPP, FCCP, professor of clinical pharmacy at the University of San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, who was not involved with the research, was not surprised by the study results. Many community-dwelling older adults have chronic medical conditions and usually visit multiple health care providers, who often do not or cannot coordinate their care, she said. Lee sees many older adults in her outpatient psychiatric practice who present with prescriptions for benzodiazepines and opioids prescribed by a nonpsychiatric provider.

“While we limit the use of these agents in our patients, it is difficult without jeopardizing the risk of withdrawal effects,” said Lee. “In our psychiatric practice, we often use SSRIs to treat mood and anxiety disorders but try to avoid those with sedating effects in older adults.”

The JAPhA findings did not specify particular SSRIs or indications.

“Many SSRIs, for example, can be prescribed safely for mood conditions without increasing the risk of falls,” said Lee. “On the other hand, gabapentin and pregabalin, which are classified as anticonvulsants, are used frequently for pain or anxiety disorders in older adults. I have personally seen increased use of these agents in younger and older patients to avoid the use of benzodiazepines.”

Haddad said they were not able to determine in the study the reason for the dramatic increase in psychoactive medication use and whether it can be attributed to prescribing behavior, consumer preferences, or changes in health care delivery and payment.

For the full article, please visit www.pharmacytoday.org for the November 2019 issue of Pharmacy Today.