The number of retirement-age Americans taking at least three psychiatric drugs more than doubled between 2004 and 2013, even though almost half of them had no mental health diagnosis on record, researchers reported on Monday.
The new analysis, based on data from doctors’ office visits, suggests that inappropriate prescribing to older people is more common than previously thought. Office visits are a close, if not exact, estimate of underlying patient numbers. The paper appears in the journal JAMA Internal Medicine.
Geriatric medical organizations have long warned against overprescribing to older people, who are more susceptible to common side effects of psychotropic drugs, such as dizziness and confusion. For more than 20 years, the American Geriatrics Society has published the so-called Beers Criteria for potentially inappropriate use, listing dozens of drugs and their mutual interactions.
In that time, prescription rates of drugs like antidepressants, sleeping pills and painkillers nonetheless generally increased in older people, previous studies have found. The new report captures one important dimension, the rise in so-called polypharmacy — three drugs or more — in primary care, where most of the prescribing happens. Earlier research has found that elderly people are more likely to be on at least one psychiatric drug long term than younger adults, even though the incidence of most mental disorders declines later in life.
“I was stunned to see this, that despite all the talk about how polypharmacy is bad for older people, this rate has doubled,” said Dr. Dilip Jeste, a professor of psychiatry and neurosciences at the University of California, San Diego, who was not involved in the new work.
The research team, led by Dr. Donovan T. Maust of the University of Michigan and Dr. Mark Olfson of Columbia University, analyzed data from annual government surveys of office-based doctors. The team focused on office visits by people 65 or older that resulted in the prescribing of at least three of a list of psychiatric, sleep and pain medications like Valium, Prozac, OxyContin and Ambien. It found that the overall number of such visits increased to 3.68 million in 2013 from 1.5 million in 2004 — nearly a 150 percent increase, partly because the population is aging but mostly because of an increased percentage of prescribing multiple medications.
“The biggest jump was in rural areas,” Dr. Olfson said, “which suggests to me that the increases partly reflect doctors and patients falling back on medications when they have little access to other options,” like talk therapy, massage or relaxation techniques.
Federal health officials recently issued a strong warning to consumers about the risks of combining sedating drugs, like Xanax or Valium, with pain medications like opiates. But the analysis found that people taking opiates were about as likely to be on at least two other drugs as those not taking the strong painkillers.
Nearly 46 percent of people with at least three prescriptions had no diagnosis of a mood, chronic pain or sleep problem, the study found.
“This is a particularly worrisome pattern and suggests some inappropriate prescribing,” Dr. Olfson said. One possible solution, he added, would be to give patients and doctors greater access to alternatives, like psychotherapy and stress management. Only about 10 percent of the visits in the analysis included one of these options.
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Older Americans’ Use of Multiple Psychotropic Drugs on the Upswing