We give our patients lots of drugs. The prevalence of use of prescription medications rose from 51% of adults in 2000 to 59% of adults in 2012, a rise of 8% in just a few years. The use of prescriptions goes up with age, of course, and over 90% of seniors take prescription drugs with 39% of seniors on 5 or more prescriptions (polypharmacy).
|< High school||57%||19%|
Use of medications goes up with income, but polypharmacy goes down. Prescription use is highest for government insurance, less for private insurance and lowest for the uninsured (31%). Use of medication goes up markedly with BMI with 73% of those over BMI on prescriptions and 29% on 5 or more medications. The lower numbers for some groups above may be more related to access to health care rather than better underlying health.
What are we prescribing?
|Drug Class||Age 40-64||Over 65|
|H2 blockers and PPIs||10.5%||22.9%|
Overall, these numbers are not too surprising. We are treating hypertension, diabetes and lipids in our older patients. Not all groups have gone up over the last 10 years. Some things have gone down – the use of hormone replacement in women over 65 dropped from 16% in 2000 to 3.9% in 2012 and antibiotic use in both older and younger patients dropped significantly over the same period.
We can try to make reasonable choices with our prescribing habits. A recent article on polypharmacy in the aging patient focused on patients with type 2 diabetes. One important finding: the first oral medication you give will, on average, lower the A1c by 1%. The second will lower it by 0.6% and the third oral agent will lower it an additional 0.2% on average. We have to consider the diminishing benefit and possible harm when we give our older patients so many medications.
For more information and a lot more data, see the two JAMA articles below.
Trends in Prescription Drug Use Among Adults in the United States from 1999-2013. Kantor, E. et al. JAMA. 2015;314(17):1818-1831
Polypharmacy in the Aging Patient. Lipska, K. et al. JAMA. 2016;315(10):1034-1045
Jim Cotter, MD