High Risk Rx Awareness

Prescription medications given to senior patients often have high risk safety concerns

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) As many age, managing medications may become a part of everyday life. Chatting with a pharmacist or doctor about any potential risks involved with prescriptions can be helpful.

A recent study looked at the rates of high risk medication prescriptions in Medicare Advantage participants in the US.

The results showed that around one in five patients was taking at least one high risk medication with the potential to increase the risk of a bad reaction and hospitalization if taken incorrectly.

"Talk to your pharmacist about Rx risks."

Danya M. Qato, PharmD, MPH, from the Department of Health Services, Policy and Practice at the Alpert Medical School of Brown University in Rhode Island, led an investigation into the frequency of high risk medications being prescribed to elderly Medicare patients.

“Since 2005, the Centers for Medicare and Medicaid Services has required all Medicare Advantage plans to report prescribing rates of high risk medications,” the authors said.

The National Committee for Quality Assurance has a list of medications that should be prescribed with caution to elderly patients due to the increased risk for hospitalization, bad reactions, healthcare costs and even death.

For this study, the researchers looked through 6,204,842 patient charts for people aged 65 and older who were enrolled in 415 Medicare Advantage plans in the US in 2009.

The following are a selection of categories of the medications on the high risk list:

  • Oral estrogens
  • Narcotics
  • Anabolic steroids
  • Thyroid medications
  • Muscle relaxers
  • Calcium channel blockers
  • Benzodiazepines (amitriptyline, diazepam, flurazepan)
  • Barbiturates (phenobarbital, butabarbital, secobarbital)
  • Antipsychotics (thioridazine)
  • Amphetamines
  • Antihistamines
  • Antianxiety medications
  • Analgesics (ketorolac)

The results showed that roughly 21 percent of Medicare Advantage enrollees were given at least one high risk medication and 5 percent were given at least two.

After adjustments, the researchers found that women were given 11 percent more of the high risk medications than men. And people in the Southern states from Texas to South Carolina were given 10 percent more of the high risk medications than people in the Northeast.

Patients with low incomes were given high risk medications at rates 7 percent higher than patients not living in low income households.

Racial minority patients 85 years of age and older were less likely to receive high risk prescriptions.

The highest rates of high risk medication prescriptions were among patients in Albany, Georgia, at a rate of 38 percent, which was four times the lowest rate found in Mason City, Iowa.

The authors said they believed the difference between high risk prescriptions to men and women was from estrogen therapy and other women-specific treatments.

Less frequent use of mental health services by racial minorities could explain the lower rates of high risk medications in those groups, the authors estimated.

The authors concluded that living in Southern states, being white, being a woman and/or having a low income increased the likelihood of receiving a high risk medication.

“This is one of the many reminders for patients to regularly review the appropriateness and safety of their medications with their pharmacists and physician. Patients are often their own best advocates,” Qato said in a press release.

“The cited study does a good job identifying the extent and demographics related to the prescribing of high risk medications (those known to cause side effects such as excessive drowsiness, dizziness or hypotension) in this elderly population sample,” Jason Poquette, BPharm, RPh, told dailyRx. 

“Some caution must, however, be exercised as we attempt to draw conclusions from this information. High risk does not necessarily mean inappropriate. All medications used for every age group require a careful consideration of their risk versus benefit. In seniors, this is even more important,” said Poquette. 

“This study is an excellent starting point to an important discussion. More thorough analysis, as the authors readily admit, will be needed to determine if other prescribing options should have been considered,” he said.

This study was published in the April issue of the Journal of General Internal Medicine.

The Agency for Healthcare Research and Quality and the National Institute of Aging provided funding for this study. No conflicts of interest were declared.

Reviewed by: 
Review Date: 
April 12, 2013
Last Updated:
August 14, 2013