Prescription drug misuse/abuse in the elderly.

Department of Medicine, Section of Geriatrics, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX, USA.
Geriatrics (Impact Factor: 1.35). 10/2008; 63(9):22-31.
Source: PubMed

ABSTRACT One quarter of the prescription drugs sold in the United States are used by the elderly, often for problems such as chronic pain, insomnia, and anxiety. The prevalence of abuse may be as high as 11 percent with female gender, social isolation, depression, and history of substance abuse increasing risk. Screening instruments for prescription drug abuse have not been validated in the geriatric population. Benzodiazepines, opiate analgesics, and some skeletal muscle relaxants may result in physical dependence; however, tolerance, withdrawal syndrome, and dose escalation may be less common in the older patient. Lower doses may decrease the risk of abuse and dependence; however, fear of abuse often results in a failure to adequately treat symptoms such as anxiety, pain, and insomnia.

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    ABSTRACT: In the thesis, we question to what degree the regular general practitioners (GPs) are responsible for the prescriptions of drugs to home-dwelling elderly, and how the prescribing pattern has developed from 2004-2007. We further question how the prevailing organization of primary care in Norway may influence drug prescriptions. Data from the Norwegian Prescription Database (NorPD) merged with data from the Regular Practitioner Database (RPD) form the basis of the analysis. Because high consumption of addictive drugs, the frequency of poly-pharmacy, and the use of many prescribers are considered to pose a risk in the medication of the elderly, we study the development of these indicators over time, and find an increase in all indicators. We also find that the regular GP is the main prescriber. Further, the results indicate, that the prevailing organization of primary health care and the way GPs are paid, influence the GPs' prescription practice. We find that the stronger competition a GP faces, the more drugs are prescribed, and indications that GPs prescribe more per list-patient, the tighter their time budget is. Several drug categories are studied, and the effects differ with drug categories.
    11/2011, Degree: PhD, Supervisor: Hilde Lurås, Erik Biørn
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    ABSTRACT: On May 23–24, 1985, the first International Sym-posium on Geriatric Nephrology was held in To-ronto. In his excellent review of the symposium, 1 Michael Kay commented on the challenges and risks facing aged individuals and, in view of the in-creased costs of their care, the ethical issues facing the caregiver. His report stressed the fact that "the degree of humanity in our healthcare world will be made evident in the way we treat (or do not treat) our minorities, our underprivileged, our poor, our mentally infirm, those who have no voice to speak for themselves, and finally, the aged." After that successful initial meeting, the Interna-tional Society of Geriatric Nephrology was formed, with its own journal—the International Journal of Geriatric Nephrology and Urology—and five addi-tional international meetings of the International Society were held at Salamanca, Lisbon, Atlanta, Thessaloniki, and Antalya. Despite all these efforts and activities, the interest among nephrologists concerning geriatric nephrology did not increase and, if anything, was decreasing. Membership in the Society and participation to the meetings were small. Also subscriptions to and sub-mission of articles to the Society's journal were not sufficient to sustain it. As a result, the publisher de-cided to publish the journal as a section in the journal International Urology and Nephrology. All these regrettable circumstances seem to have changed because of two important factors that have contributed to a renewed interest in geriatric ne-phrology. First is the amazing increase in the inci-dence of new patients with ESRD over the age of 65; this segment of our population is the fastest grow-ing group of patients requiring dialysis, and it con-tinues to grow. Thus, nephrologists forced to prac-tice as amateur geriatricians now recognize the need to master all aspects of geriatrics. Second, the intro-duction and automatic reporting of estimated GFR (eGFR) using the Modification of Diet in Renal Dis-ease (MDRD) formula has revealed a large number of patients who have impaired kidney function, most of whom are elderly. Primary care physicians are inundated with elderly patients with impaired kidney function and, in turn, are flooding the neph-rologists with referrals. Nephrologists have had to take a serious look at the plight of elderly, and probably as a result, three important developments have ushered in the new era of Geriatric Nephrology. 1. For the first time, the American Society of Nephrology has in-cluded in its annual Renal Week program a 2-d course on geri-atric nephrology that was sold out and that kept the interest of the participants to the end. All these presentations have been taped and are available, with the accompanying slides, at http:// A similar course has been planned for the 2009 ASN meeting.
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