Polypharmacy, often defined as the use of five or more medications, is prevalent in adults ages 65 and older, with 40% taking 5-9 medications and 18% taking 10 or more.1 While drug-drug interactions and side effects are possible in all age groups, they are more prevalent in patients over 65, especially for certain medications. The American Geriatric Society publishes the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, which lists medications that should not be prescribed for patients 65 and older in most circumstances due to likely adverse events, like confusion.1
We wondered how many patients 65 and older continue to receive medications that the Beers Criteria suggest clinicians avoid prescribing. We limited our analysis to outpatient medications that are recommended to always avoid in patients 65 and older and excluded medications with conditional recommendations, such as diphenhydramine. We found that, of the 11.6 million patients 65 or older, about 2.4 million, or more than one in five, were prescribed medications from at least one of seven Beers Criteria categories between 2018 and 2020.
In order of prevalence, the following medication classes were most often prescribed to the elderly, despite being on the Beers list as “recommended to avoid”:
- Anticholinergics, such as promethazine, meclizine, and hydroxyzine
- Pain medications, such as cyclobenzaprine, methocarbamol, and ketorolac
- Central nervous system (CNS) medications, such as zolpidem, amitriptyline, and paroxetine
- Endocrine medications, such as chlorpropamide and megestrol
These findings suggest an opportunity to increase adherence to Beers Criteria recommendations, thereby decreasing polypharmacy and reducing the prescribing of medications that have an increased likelihood of interactions and side effects in the elderly.
