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 Nationwide, the number of annual doctor visits involving patients 65
and older who started or were already taking at least three
psychotropic drugs surged from 1.5 million in 2004 to 3.68 million
in 2013, the study estimated.
"This is not among patients with diagnoses like depression, anxiety,
or insomnia, but rather in patients with pain and in patients with
no mental health or pain diagnosis," noted lead study author Dr.
Donovan Maust of the University of Michigan in Ann Arbor.
"As with other organs, an aging brain may have more difficulty
maintaining its 'normal' function," Maust said by email. "As you add
additional chemicals that influence the brain, it makes sense that
some of these may help the brain, but the more you add, the more
they might have negative effects."
These drugs can sometimes help patients with problems like insomnia
or chronic pain, but they are often unnecessary. Routinely taking
several of these drugs at once can be dangerous and U.S regulators
have warned that certain cocktails such as a mix of opioids and
antidepressants can be deadly, the study team writes in JAMA
Internal Medicine.
To examine how often seniors are taking cocktails of these
medicines, researchers examined data on doctor visits for 97,910
patients aged 65 and older between 2004 and 2013.
Overall, the proportion of checkups when seniors got at least three
psychotropic medicines prescribed or refilled increased from 0.6
percent of visits to 1.5 percent during the study period.
For rural patients, the proportion of checkups when seniors got at
least three of these drugs surged from 0.7 percent of visits to 2.2
percent by the end of the study.
The increase was also steep for patients 85 and older, who got at
least three psychotropics at 0.4 percent of visits at the start of
the study period and at 1.5 percent of checkups by the end.
Roughly half of the patients taking at least three psychotropics
didn't have pain or a mental health condition, and drug cocktails
were much more commonly prescribed by family practitioners than by
psychiatrists.
One limitation of the study is that researchers lacked data on
whether medications were prescribed as needed for short-term use,
which the authors note may have led them to overestimate routine use
of drug cocktails.
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Even so, the findings suggest that patients and families should
exercise caution when considering whether to take more than one
psychotropic medicine at a time, said Dr. Dilip Jeste, a psychiatry
researcher at the University of California, San Diego, who wasn't
involved in the study.
"Older adults receiving several medications, and their family
members when appropriate, should ask their prescribing physician
about why each of those medications is being given," Jeste said by
email.
As part of this discussion, they need to tell the physician about
all the medications they take as well as over-the-counter remedies
such as cough medicines, pain relievers, vitamins and supplements,
Jeste added. All of these things, as well as smoking and drinking,
can influence the potential for side effects.
Many older adults also have memory difficulties and problems taking
medications exactly as prescribed, Jeste added.
"I have seen patients take the less important ones while forgetting
the 'must take' medications," Jeste said. "Having a discussion with
the physician is critical."
SOURCE: http://bit.ly/2lgJIFm JAMA Internal Medicine, online
February 13, 2017.
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