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Doctors must exercise caution while prescribing medicines to elders

A study led by researchers at the San Francisco VA Medical Center has shown that Doctors have a tendency to under prescribe or over prescribe medications for elders. //Nearly 40 percent of patients who took part in the study were consuming at least one unsuitable medication along with other medications, according to lead author Michael Steinman, MD, a staff physician at SFVAMC.

"It's not just a question of, 'are you taking too much or too little'," says Steinman, who is also an assistant professor of medicine at the University of California, San Francisco (UCSF). "Physicians need to look at both sides of the equation, and be attentive to different kinds of prescribing problems that potentially coexist within the same patient."

The study appears in the October 2006 issue of the Journal of the American Geriatrics Society.

The researchers observed 196 outpatients – 194 of them male – aged 65 or older who were taking five or more prescribed medications and receiving care at a Veterans Affairs Medical Center. A pharmacist analyzed each patient's medical record and medication list for potential problems.

Sixty-five percent of patients were taking a drug that was ineffective, not indicated, duplicative of another medication, or considered generally inappropriate for older persons. Sixty-four percent were not taking a drug that would have been appropriate for a medical condition they had. Together, 42 percent were simultaneously taking an inappropriate drug and not taking an appropriate drug. Only 13 percent were taking all drugs appropriate for their conditions and not taking inappropriate drugs, according to the pharmacist's analysis.

Overall, note the study authors, "inappropriate medication use rose rapidly as the total number of drugs taken by a patient increased," while under-use of medications was "common and constant at all levels of medication use," with an average of one under-used medication per patient.

"Perhaps in patients taking relatively few medications, we should focus more on what other drugs might be beneficial. In patients taking many medications, we need to be vigilant about drugs that are underused as well as drug that are overused," concludes Steinman.


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