Prescription Drug Use in 1984 and Changes Over Time

Baum, Carlene; Kennedy, Dianne L.; Knapp, Deanne E.; Juergens, John P.; Faich, Gerald A.

doi:10.1097/00005650-198802000-00002

Cited by 54 publications

(20 citation statements)

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“…Diuretics and other antihypertensive agents are among the leading prescription drugs in the United States, 1 , 2 , 28 , 38 and simplifying their administration accounted for a substantial number of our study recommendations. Antiplatelet agents were a particular problem in our clinic, where a number of patients were taking both dipyridamole and aspirin, often for a past history of vague, nonrecurrent symptoms, such as dizziness or numbness.…”

Section: Discussionmentioning

confidence: 99%

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Reducing Polypharmacy in the Elderly

Kroenke¹,

Pinholt²

1990

J American Geriatrics Society

119

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A prospective, controlled trial to reduce polypharmacy in patients 65 years or older was carried out in the residents' clinic of a teaching hospital. Of 272 elderly patients surveyed, 89 (33%) were taking five or more prescription drugs. Recommendations to discontinue medications or to simplify regimens were formulated for 79 polypharmacy patients. Compared to 41 controls, the 38 patients whose physicians were informed of the recommended changes demonstrated a small but significant reduction in the mean number of drugs, the complexity, and the cost of their regimens. Physicians complied with eight (100%) of eight recommendations to simplify a dosage schedule, eight (62%) of 13 recommendations to substitute a new drug for the old one, and only eight (40%) of 20 recommendations to stop a medication (P = .04). Noncompliance usually resulted from patient refusal or from medications being prescribed by another provider. Whereas feedback to the primary physician is beneficial, more substantial reductions in outpatient polypharmacy may require overcoming patient barriers and limiting the number of prescribing physicians.

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Section: Discussionmentioning

confidence: 99%

“…Their usage has expanded, however, to the chronic therapy of nonulcer dyspepsia, where their benefit remains unproven 39 . The overutilization of tranquilizers has been declining in the United States 38 and was not a problem in our clinic.…”

Section: Discussionmentioning

confidence: 99%

Reducing Polypharmacy in the Elderly

Kroenke¹,

Pinholt²

1990

J American Geriatrics Society

119

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“…After peaking in the early 1970s, use of minor tranquillisers decreased in the US by 34% from 1975 through to 1981 (Baum et al 1988) and has continued to diminish at a slower rate through to 1989 (Baum unpublished findings). The reasons for this curtailment include further prescribing restrictions (outlined below) and an increasingly stoic attitude towards the treatment of anxiety by physicians (Hamilton et al 1990;Morgan 1983) and the public (Clinthome et al 1986).…”

Section: Historymentioning

confidence: 99%

“…Furthermore, long term use of benzodiazepines occurs frequently in this age group. Thus, while the studies discussed above found little evidence to substantiate the existence of the stereotypical middle-aged 'pill popper', the use of these agents in older persons is a public health issue of considerable interest (Beers et al 1988;Mellinger et al 1984) In the US persons over 60, who comprise 17% of the population, receive 35% of all prescriptions for benzodiazepine and nonbenzodiazepine minor tranquillisers (Baum et al 1988). However, the prevalence of drug use in a given population as determined from prescription data may not be accurate because the number of prescriptions per person is unknown as is the actual consumption.…”

Section: Epidemiology Of Benzodiazepine Use In Older Adultsmentioning

confidence: 99%

Rational Use of Benzodiazepines in the Elderly

Shorr

Robin

1994

Drugs & Aging

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In the 40 years since the introduction of benzodiazepines into clinical practice, considerable controversy has surrounded their use. While there is little evidence to suggest widespread abuse or long term use in most age groups, benzodiazepines continue to be widely prescribed to older adults in both community and long term care settings. Several studies have described an increased sensitivity to the clinical effects and toxicity of benzodiazepines in older adults. However, it is unclear whether these observations are attributable to age-related changes in benzodiazepine pharmacokinetics or pharmacodynamics. Benzodiazepines are the safest and most effective agents available for the pharmacological management of symptoms of anxiety and insomnia. However, the acute administration of benzodiazepines is associated with impairments in cognition, memory, coordination and balance, and long term use, even at therapeutic dosages, has been associated with symptoms of withdrawal upon abrupt discontinuation. Therefore, it is essential that the practitioner develop a treatment plan when utilising these agents to treat older patients. This plan may also involved the implementation of psychotherapy or other nonpharmacological modalities in the management of anxiety or insomnia. Although we recommend initiating benzodiazepines using the lowest available dosage, older patients should be treated with enough drug to produce a therapeutic response. For most clinical situations of anxiety or insomnia, we recommend prescribing limited quantities (e.g. a 2-week supply with a return visit for re-evaluation of effectiveness and adverse effects) of a drug with a short elimination half-life. Persistent anxiety or insomnia in the elderly may require a medical and possibly psychiatric evaluation. If benzodiazepines are used continuously for 6 weeks or longer, we recommend a gradual taper over 2 to 12 weeks with frequent follow-up to evaluate for signs of withdrawal or the return of symptoms.

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“…Up to one-third of prescriptions for BZD and non-BZD minor tranquillizers are issued to individuals over 60 years of age (Mellinger et al, 1984;Baum et al, 1988). Up to one-third of prescriptions for BZD and non-BZD minor tranquillizers are issued to individuals over 60 years of age (Mellinger et al, 1984;Baum et al, 1988).…”

mentioning

confidence: 99%