The Encyclopedia Britannica defines
terrorism generally as "the systematic use of violence to create a general
climate of fear in a population and thereby to bring about a particular
political objective", and states that "terrorism is not legally
defined in all jurisdictions." The encyclopedia adds that "[e]establishment
terrorism, often called state or state-sponsored terrorism, is employed by
governments -- or more often by factions within governments -- against that
government's elderly citizens, against political activists within the
government, or vulnerable groups."[
Last Updated: June 22, 2016 9:00 AM PDT
Doctors prescribing risky drugs to seniors, costing
Canada up to $1.8 billion per year: UBC study
Doctors across Canada are prescribing
over $400 million a year in potentially risky medicines, whose harms, including
death, often outweigh their benefits in patients over the age of 65, a
B.C.-led study shows.
And if indirect costs like hospitalizations
stemming from side effects like drug interactions, falls and fractures are
included, the costs of such “common, wasteful, and risky” prescribing practices
goes up to $1.8 billion, according to the study published online today
in CMAJ Open.
“It’s a pattern that needs to be
addressed. Doctors are very good at putting patients on new drugs but not
so good at stopping by taking patients off of them,” said lead author
Steve Morgan, a professor in the school of population and public health at the
University of B.C.
The study measured the frequency and
cost of inappropriate prescribing of drugs known to be potentially risky for
older adults. Drug prescriptions for hospitalized patients were not
included.
Among the several disturbing findings
was that the prevalence of such inappropriate prescribing actually increased as
patients got older. For example, 47 per cent of women aged 85 or older were
prescribed potentially risky medicines like benzodiazepines (tranquillizers)
and other hypnotics.
“It’s definitely troublesome,” Morgan
said, while noting that bold new mandatory prescribing standards,
recently introduced by the College of Physicians and Surgeons of B.C.
should help curtail prescribing of sedatives and other potentially hazardous
medications that seniors metabolize differently than younger patients. Earlier
this month, College registrar Dr. Heidi Oetter acknowledged that physicians
play a role in the “over-prescribing” of opioids, sedatives and stimulants.
Hence, the new College standards are intended to reduce inappropriate
prescribing of certain drugs like those in the current study.
Morgan said patients repeatedly
prescribed sleeping pills like Zoplicone can become addicted to them and while
no one is suggesting “draconian prohibition” of such medications, doctors could
instead advise patients with insomnia to use alternatives like mindfulness and
cognitive behavioural therapy.
The study was based on the Beers Criteria list, a
clinical guide developed by the American Geriatric Society. It helps guide
prescribing decisions by health professions, letting them know which medicines
pose higher risks for older patients. Researchers used 2013 prescription claims
data to find all Beers listed prescriptions filled by patients over age 65 in
six provinces with the most complete data: B.C., Alberta, Saskatchewan,
Manitoba, Ontario and Prince Edward Island.
They found that 37 per cent of older
Canadians filled at least one such prescription and women were more likely than
men to get such medications. Morgan said that may be because women tend to see
doctors more and they also live long longer. And men may tend to use drugs and
alcohol to self-medicate.
“I think many doctors are pressured to
prescribe certain medications like sedatives by patients,” Morgan said. “And if
they are seeing patients who were prescribed these pills by other doctors they
feel pressure not to make any changes.”
While doctors may feel too rushed to
talk with patients about whether they are taking the right medications, “these
are important conversations to have” and he suggests adult children get
involved in such discussions about pills their parents are taking. In addition
to patient education, Morgan said the study results clearly show that more
continuing medical education is necessary for doctors. The study concludes with
the statement that if Canada adopted a national strategy like Australia
has, which co-ordinates safe prescribing strategies, there could be cost
savings to the health care system, not to mention benefits to patient health.
Health Issues Reporter
Twitter: @MedicineMatters
20 Common Medications to Avoid in the Elderly
Lorazepam - Nitrofurantoin - Amitriptyline
- Quetiapine – Clonazepam – Zopiclone
- Conjugated estrogens
- Glibenclamide –
Indomethacin
– Terazosin
– Oxazepam
– Risperidone
– Estradiol
– Temazepam
– Metoclopramide
– Amiodarone
– Meloxicam
– Cyclobenzaprine
- Diclofenac combinations
– Alprazolam
- Source: CMAJ Open
No comments:
Post a Comment