ElderWeb

The National Institute on Drug Abuse (NIDA) has issued a new research report that says that 17% of adults aged 60 or older may be affected by prescription drug abuse. They report that elderly persons use prescription medications three times as frequently as the general population and have the poorest rates of compliance with directions for taking medications. Other data suggest that elderly patients may be prescribed inappropriately high doses of some medications and may be prescribed these medications for longer periods than are younger adults, even though older people should be usually be prescribed lower doses of medications because the body's ability to metabolize many medications decreases with age.

They also point out an association between age-related morbidity and abuse of prescription medications. For example, elderly persons who take benzodiazepines are at increased risk for falls that cause hip and thigh fractures, as well as for vehicle accidents and cognitive impairment.

The Office of the Inspector General (OIG) of the Department of Health and Human Servies has investigated the oversight of the Food and Drug Administration (FDA) of dietary supplements. Unlike new prescription and over-the-counter drugs, dietary supplements do not undergo FDA premarket approval for safety and efficacy. Therefore, FDA must rely on its adverse event reporting system to identify safety problems. This inspection found that the adverse event reporting system is inherently limited as a tool to safeguard consumers. As is true of most adverse event reporting systems, FDA's system detects relatively few adverse events. For those that are reported, FDA often lacks important information, such as medical information, product and manufacturer information, and clinical information. With limited information, FDA rarely reaches the point of knowing when to take a safety action. The OIG made several recommendations to FDA to address this shortcoming

Emily R. Cox, PhD of Express Scripts, Inc, led a study of how Medicare beneficiaries behave when they have drug costs which exceed the "cap" in their MediGap policy or their Medicare HMO. This cap is the maximum amount that the insurance company will cover, leaving the beneficiary to pay additional costs out-of-pocket. The study found that when the cap was reached, many patients took steps which could have significant impact on their treatment and disease management (some reported taking multiple steps):

* 38% tried obtaining samples from a physician
* 24% took less medication than prescribed
* 20% took over-the-counter (OTC) medications to replace prescribed therapies
* 16% discontinued a medication to reduce out-of-pocket prescription expenses
* 10% tried purchasing a prescribed medication in Mexico
* 5% used a medication prescribed for someone else

To pay for medications, about 15% of respondents said they went without necessities, defined as food, clothing, or shelter, and 12% said they borrowed money to pay for prescription medications. The study was reported in the March issued of Medical Care.

Generations Magazine has devoted its current issue to the subject of pharmaceuticals and the elderly. Guest editor Janice L. Feinberg reports that the economic impact of medication-related problems in people age 65 and older may be as high as $60 billion annually, rivaling the cost of Alzheimer's disease, cancer, cardiovascular disease, and diabetes, and that medication-related problems may be the third or fourth leading cause of death in the over-65 age group. Other articles in this issue discuss age-related risk factors in pharmaceuticals, "senior care pharmacists", and Internet pharmacies.

Health Affairs has issued a special collection of articles about costs and utilization of prescription drug insurance coverage. In one article, authors Bruce Stuart, Dennis Shea, and Becky Briesacher investigate not only the number of Medicare beneficiaries who have insurance that pays for drug costs, but also the number of people who have had changes in their drug coverage. They found that over half the Medicare beneficiaries had some sort of interruption in their drug coverage from 1995 to 1996. These people are categorized into "finders" -- those who started out without coverage but found it by the end of the two year period and "losers" -- those who started out with coverage and lost it. Many others had coverage provided by one or more different providers over this time period.

The authors found that the people most likely to have lost coverage for prescription drugs during the two year period of the study were older people living in the midwest or in rural areas, those most likely to have added coverage when they didn't have it initially were younger people living in the west. They found that people living in states with prescription drug coverage plans were most likely to have had continuous coverage for prescription drugs, and, not surprisingly, low income people who qualified for public benefits (usually Medicaid) were also likely to have had continuous coverage. Since the highest income people generally had continuous coverage, the group most likely to lack coverage were middle income seniors.

The authors contend that all this instability is a strong argument for making drug coverage a regular part of the Medicare program. Data is probably not yet available to do so, but it would be quite interesting to see how patterns have changed since 1996, considering the turmoil in Medicare HMOs that forced about 2 million Medicare beneficiaries to find new plans from 1998-2000 and the huge increases in drug and insurance costs since that time.

>> Health Affairs

The American Society of Health-System Pharmacists (ASHP) revealed results of a survey that shows that over half of all Americans are taking multiple medications each day, including prescription and nonprescription medications, herbal supplements, and vitamins. The survey showed that 51% are taking more than one medication of any kind each day, 46% are taking at least one prescription medication each day, 28% are taking multiple prescription medications a day, and 40% are taking multiple herbal supplements or vitamins each day. Of people age 65 or older, 79% are taking at least one prescription medication a day, with an average of 4 prescription medications a day.

Although these medications could have a serious impact on their hospital care, the survey found that only 8% told hospital staff what medications they were taking, and only 3% brought samples of their medications with them to the hospital.

ASHP President Mick L. Hunt, M.S. said, "We want patients to be aware of the potential for drug interactions that can occur when mixing all of these remedies, especially when taking multiple medications each day. Patients and customers should know that they can always turn to their pharmacist for answers to their medication-related questions."

The Social Security Administration (SSA) wants veterans to know about an important prescription drug benefit available from the Department of Veterans Affairs (VA). A 30-day supply of prescription medications costs only $2 through the VA, and disabled or low-income veterans can receive medications for free. To take advantage of this benefit, a veteran must have been honorably discharged from the military, must enroll with the VA, and must be seen by a VA doctor. The VA may charge for a doctor visit, but your insurance may cover this charge (disabled or low-income veterans can visit doctors for free). If you would like to find out more about this and other health benefits through the VA, you can call, toll-free, 1-877-222-VETS (1-877-222-8387). For information about military service and Social Security, check out a SSA fact sheet.

>> SSA Fact Sheet

A report published by Mayo Clinic physicians in the November edition of Mayo Clinic Proceedings states there is insufficient data to conclude that soy isoflavones are an acceptable alternative to estrogen for hormone replacement in postmenopausal women.

The Mayo physicians studied available literature in response to recent interest in the use of natural products like soy proteins for their potential estrogen-like effects. Soybeans are a staple in the diet of East Asian countries. In areas with soy-enriched diets, there appear to be lower incidences of hormone-dependent diseases such as breast and ovarian cancer and coronary artery disease. The theory is that soy phytoestrogens, specifically isoflavones, are partly responsible for this protection, so there has been intense interest in the isoflavones as substitutes for estrogen for postmenopausal women.

The authors of the Mayo Clinic report looked at various studies about isoflavones and the effects they have on coronary artery disease, breast cancer prevention, bone loss, the central nervous system, the endometrium, hormonal effects, attenuation of hot flashes and the skin. They determined that it is premature to draw definitive conclusions regarding the use of isoflavones as an alternative to estrogen for hormone replacement in postmenopausal women. Appropriate dosage studies with the widely available isolated isoflavones have not been done and long-term benefits of isoflavones with regard to fracture prevention, prevention of hormone-dependent cancers, attenuation of memory loss, and prevention of cardiovascular disease are currently unknown. Randomized, placebo-controlled clinical trials are necessary to address these important issues.

Mayo Clinic Proceedings is a peer-reviewed and indexed general/internal medicine journal, published for 75 years by Mayo Foundation, with a circulation of 120,000 nationally and internationally.

The American Society of Anesthesiology has issued an alert to patients that they should stop taking herbal medicines at least two weeks before surgery to prevent potentially dangerous interactions with drugs administered during surgery. This will allow time for the herbal medications to completely clear the body. They say that recent findings disclose that seven out of 10 herbal medicine users never tell their physicians about the herbal products they are taking. Most believe that since the products are "natural," they must be safe, but many of these products are quite potent and can be dangerous, especially if the patient's anesthesiologist or surgeon does not know that the patient is taking them, he said.

For example, St. John's wort, which is taken by more than 7.5 million Americans to treat anxiety, depression and sleep disorders, may intensify or prolong the effects of some narcotic drugs and anesthetic agents. Ginko biloba is used by almost 11 million Americans to improve their memory and increase blood circulation, but it may reduce platelets, which are needed for blood to clot. The herbal feverfew also appears to interfere with blood clotting. Ginseng, one of the most popular herbal preparations in the world, taken to boost vitality, has been associated with episodes of hypertension (high blood pressure) and tachycardia (rapid beating of the heart).

The Surgeon General has issued a flu vaccine alert. The Centers for Disease Control (CDC) has been warning of an expected shortage of flu vaccine this winter, but the Surgeon General reports that there will be no shortage, but there is a delay in the availability of sufficient quantities of flu vaccine to vaccinate everyone before December, as has been the case in the past. Because of this, the Surgeon General has asked Americans who are not considered high priority or high risk to wait for their flu shots until after the highest priority populations have been taken care of.

The highest priority is being given to the elderly, pregnant women, and health care workers. Everyone else is being asked to defer their shots until December, when the supply is expected to expand. The Surgeon General also urged seniors not to use this shortage as an excuse to delay getting their shots, since the flu vaccine has been demonstrated to be very effective in reducing deaths from influenza in the older population.