Are Older Adults Prescribed Too<br > Many Drugs?<br >There are 42.3 million older adults， that is， O 24% used a gastrointestinal drug (for<br >people 60 and over， living in the United ulcers， constipation， colitis， etc.).7<br >States.I In 1991， older Americans filled 650 An even larger proportion of older adults<br >million prescriptions for drugs at retail in nursing homes were being given drugs<br >drugstores， for an average of 15.4 prescrip- in each of these therapeutic categories，<br >tions per person.2 Thus， although people especially the mind-altering drugs which<br >60 and over make up just 16.7%， one-sixth， were used by 61% of 65 to 84-year-olds.<br >of the population， they use 38.5%， of the Although older adults do have more<br >prescription drugs3 at an annual cost of chronic diseases than those who are<br >well over $14.5 billion. All other Ameri- younger and therefore may need more<br >cans got an average of only 4.9 prescrip- drugs than younger people， there is mount-<br >tions per year， less than one-third as many ing evidence that many of our older citi-<br >as older adults.4 zens are getting prescription drugs which<br > Another way of looking at the problem of are entirely unnecessary (the wrong diag-<br >too many drugs for older adults is to ask how nosis has been made or nondrug therapy<br >many different drugs an average person takes would work)， they are getting a more<br >in a year， since some of the 15.4 prescriptions dangerous drug when a much less danger-<br >per person are refills. A survey of older adults， ous one would work (a Worst Pill， instead<br >this time people 65 and over， found that 61% of a safer pill)， or a lower dose of the same<br >of people 65-84 years old dwelling in the drug would give the same benefits with<br >community (not in nursing homes or the lower risks.<br >hospital) got three or more different pre- A very serious problem concerning the<br >scription drugs in a year， 37% got five or use of drugs by older adults is that many of<br >more， and 19% got seven or more different the "illnesses" for which they seek and are<br >drugs? (In nursing homes， an even larger， given drug treatment are problems which<br >proportion of people were given an extraordi- are， in fact， adverse drug reactions to drugs<br >nary number of drugs， with 34% of 65- to already being used which were not recog-<br >84-year-old residents getting seven or more nized by either patient or doctor as such.<br >different prescription drugs in a year.)6 In Chapter 2， Adverse Drug Reactions，<br > Yet another way of measuring the extent p. 9， we list common adverse drug reactions<br >of prescription drug use by older adults is which might be mistaken for diseases in<br >to find out what percentage are using older people. These "diseases，" in this case<br >different categories of drugs. The same drug-induced， include memory loss， confu-<br >study mentioned above found that: sion， depression， parkinsonism， falls and<br >O 65% of people 65 to 84 (who were not in hip fractures， constipation， and urinary<br > nursing homes or hospitals) took a incontinence. We list， for each kind of<br > cardiovascular drug (for heart disease， adverse reaction， the drugs that have been<br > high blood pressure， or other heart/ shown to cause it.<br > blood vessel diseases) and 33% used a A recent review of 19 studies measuring<br > psychotropic drug (tranquilizer， sleeping the appropriateness of medication use on<br > pill， or antidepressant); the elderly -- looking at the prescribing<br >