Study shows decrease in seniors taking potentially harmful drugs between 2000 and 2006

New CIHI analysis shows that more than a quarter of seniors continue using these drugs

The proportion of seniors taking potentially harmful drugs decreased over the last six years, from more than one in three seniors (34%) on prescribed medication in 2000–2001 to just over one in four seniors (27%) in 2005–2006. A new study released today by the Canadian Institute for Health Information (CIHI), Drug Claims by Seniors: An Analysis Focusing on Potentially Inappropriate Use of Medications, 2000 to 2006, examines public drug program claims in Alberta, Saskatchewan, Manitoba and New Brunswick. The study focuses on medications on the Beers list—an internationally recognized list of medications identified as “potentially inappropriate” for seniors because of an elevated risk of adverse effects. First developed in 1991 by U.S. gerontologist Dr. Mark H. Beers, the list was developed using criteria such as appropriate use of medication, effectiveness, risk of adverse events and the availability of safer alternatives.

“Prescription drug therapy is a very important component of health care delivery for the elderly in this country. As the Canadian population ages, a better understanding of any potentially inappropriate use of these drugs is essential,” says Francine Anne Roy, Director of Health Resources Information at CIHI.

Top five Beers list drugs claimed are similar across the four provincial drug programs

The study noted a decline in the chronic use of drugs from the Beers list in all four provinces. Chronic use of medications on the Beers list is described as a minimum of three prescriptions and 100 solid dosage units in a given year. In 2000–2001, chronic use ranged from 19.5% of seniors with drug claims in Manitoba to 27.5% in New Brunswick. This range was from 12.9% in Alberta to 18.8% in New Brunswick in 2005–2006.*

“Our analysis shows a decline in the overall use of drugs on the Beers list. This is not surprising considering increased awareness around the safety and benefits of some of these medications, including oral conjugated estrogens, used for hormone replacement therapy,” says Michael Hunt, Manager of Pharmaceuticals at CIHI. “On the other hand, the use of other drugs on the list appears to be increasing. The chronic use of amitriptyline, an antidepressant that carries high potential health risks, has increased over five years, making it the fastest-growing drug on the Beers list in terms of usage in all four provinces.”

In 2005–2006, the top five Beers list drugs most prescribed and claimed, by number of chronic users, were similar between the four provincial drug programs. Overall, the top five were:

Oral conjugated estrogens—hormone replacement

Amitriptyline—an antidepressant

Digoxin—a treatment for heart conditions

Oxybutynin—a treatment for incontinence

Temazepam—a treatment for sleep disorders

A sub-category of Beers drugs labelled “high risk,” identified originally by Dr. Beers and subsequently by a United States consensus panel of experts in their 2003 update of the Beers list, are of particular concern due to the potential for “adverse outcomes of high severity.” Between 2000–2001 and 2005–2006, chronic use of Beers drugs considered to be high risk decreased in all four provinces. In 2005–2006, the use varied from 8.2% of seniors with drug claims in Alberta to 12.0% in New Brunswick. Among the number of potential effects on seniors using these medications are unwanted changes in blood pressure, confusion, sedation and dizziness.

The chronic use of more than one Beers drug occurred, on average, in less than 2% of all seniors using medications in the four provinces. CIHI’s analysis found chronic Beers list medication use increased with age and was highest among women and seniors aged 85 and older.

The proportion of seniors who had drug claims accepted by the public drug programs in the four provinces varied from 59% in New Brunswick to more than 90% in Manitoba, Saskatchewan and Alberta.

About CIHI

The Canadian Institute for Health Information (CIHI) collects and analyzes information on health and health care in Canada and makes it publicly available. Canada’s federal, provincial and territorial governments created CIHI as a not-for-profit, independent organization dedicated to forging a common approach to Canadian health information.

CIHI’s goal: to provide timely, accurate and comparable information. CIHI’s data and reports inform health policies, support the effective delivery of health services and raise awareness among Canadians of the factors that contribute to good health.