Pitfalls of high-risk prescribing

For many aged 65 years and older, good health and longevity is only achievable with the help of prescription drugs. However, researchers have found that some ‘high-risk’ prescribing practices may be a cause for concern among older adults.

High-risk prescribing practices include polypharmacy (the use of five or more prescription drugs) and the use of drugs with sedative or anticholinergic properties, including antipsychotics, benzodiazepines and antiparkinsonian drugs. Such practices have been previously shown to be associated with physical frailty among older adults, and physical frailty corresponds with a risk of physical disability.

In a new study researchers, led by the University of Tsukuba, Japan, evaluated the relationship between high-risk prescribing practices and an increased risk of disability.

In Japan, people who are aged 65 years and older and have a functional disability are eligible to receive long-term care (LTC) services. To receive these services, an LTC needs certification is granted based on the assessment of an applicant’s eligibility and care requirements. Using the certification as a proxy for disability among older adults in Japan, researchers conducted a population-based nested case-control study. They identified and control-matched over 2100 cases who received their first long-term care needs certification within the observation period.

“To conduct our analysis, we used two health insurance datasets to form a comprehensive cohort that included 89% of Japanese adults aged 65 years and older as of October 2018,” said lead author Dr Naoaki Kuroda.

“We found that both polypharmacy and the use of drugs with sedative or anticholinergic properties exhibit dose-response relationships with the risk for LTC needs certification,” said senior author Professor Nanako Tamiya.

“In other words, these high-risk prescribing practices are associated with an increased risk of disability among older adults.”

The findings of this study may encourage the development of public health initiatives regarding high-risk prescribing practices among older adults. Additional research is needed to determine whether a reduction in high-risk prescribing practices corresponds with a reduction in the risk of disability.

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