Older adults are still taking too many potentially inappropriate medications, concludes a new study led by a researcher at the Research Institute of the McGill University Health Centre.
These are drugs whose harms may outweigh the benefits; which may be ineffective; or for which there is a safer alternative.
“Although spending on (potentially inappropriate medications, or PIMs) has declined in Canada, the overall cost remains high,” the study authors write. “Prescribing of some classes of seriously harmful PIMs has increased, and targeted and scalable interventions are needed.”
Dr. Emily McDonald and colleagues found that, despite some improvements since 2013, the prescribing of potentially inappropriate medications remains very common among Canadian seniors, with 42% of Canadians over the age of 65 reportedly taking at least one MPI in 2021.
The situation is not all negative, however. For example, while the population aged 65 and over increased by 32% between 2013 and 2021 in Canada, total spending on MPI for seniors declined by 33.6%, from $1.5 billion to $1 billion. Quarterly spending per senior exposed also decreased from $95 to $57.
Total spending on MPIs decreased in all categories between 2013 and 2021, with the exception of gabapentinoids (a jump of 36.4%) and antipsychotics (a rise of 7.2%).
The authors point out, however, that the reduction in the price of many drugs, rather than a decline in the number of prescriptions, is responsible for most of the savings.
The example of gabapentinoids illustrates the situation well. These anticonvulsant agents 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 ten most prescribed drugs in North America, and are reportedly prescribed inappropriately in 83% of cases.
“Off-label use of gabapentinoids” is increasingly recognized as a major problem in North America, and escalating trends in misuse and abuse “are contributing to harm,” the authors warn.
“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.
The prescribing of MPIs stems partly from the lack of pharmaceutical options for certain conditions, but also from the sometimes difficult or expensive access to non-pharmaceutical options, such as the services of a physiotherapist, she added.
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 that the medication is not appropriate and could cause side effects, McDonald admitted.
“It’s a very complex problem,” she said.
Beyond the financial cost of prescriptions, the use of these drugs therefore carries an excessive risk of adverse events, such as falls, fractures, cognitive impairment and death. Their use therefore 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.