Status of Polypharmacy Use, Drug Knowledge, Drug Misuse and Drug Adherence of the Elderly in the Community

There is no dearth of speculation about the use and misuse of drugs among older persons in American society. Scattered reports have indicated that the elderly increasingly use and misuse a wide variety of drugs, and in very recent years much public attention and concern has been directed toward this problem in the older population. Factual information, however, particularly incidence of use and factors related to elderly drug misuse, is scarce. This paper presents both a review of the relevant literature and a summation of available research evidence with particular reference to patterns of use of legal drugs, the types and extent of misuse of legal drugs, and the issue of illegal drug abuse by the elderly. Conclusions are provided as to what is known at this time regarding elderly drug use and misuse as well as some suggestions regarding future research that might contribute to an understanding of drug-using behavior among the elderly.

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Shorter drug testing intervals are associated with improved drug misuse rates

Journal of Opioid Management ◽

10.5055/jom.2020.0591 ◽

2020 ◽

Vol 16 (5) ◽

pp. 357-373

Author(s):

Jeff Gudin, MD ◽

Neel Mehta, MD ◽

F. Leland McClure, PhD ◽

Justin K. Niles, MA ◽

Harvey W. Kaufman, MD

Keyword(s):

Chronic Pain ◽

Drug Testing ◽

Drug Misuse ◽

Drug Adherence ◽

Potential Drug ◽

Serial Testing ◽

Urine Drug Testing ◽

Clinical Strategies ◽

Urine Drug ◽

Control And Prevention

Objective: The Centers for Disease Control and Prevention (CDC) recommend that clinicians prescribing opioids for chronic pain should consider at least annual urine drug testing (UDT). We evaluated whether shorter intervals for repeat UDT are associated with decreased rates of drug misuse.Design: Retrospective analysis of deidentified serial UDT and matched prescribing data.Setting: We analyzed Quest Diagnostics 2016-2017 UDT results from new patients being monitored for prescription drug adherence, in nonsubstance use disorder (SUD) treatment environments.Main Outcome Measures: Drug misuse was defined as the absence of a prescribed substance or the presence of a nonprescribed substance. Patients with ≥3 sets of the UDT results were included.Results: UDT results from 49,601 patients (148,803 specimens) were tested. Declines in misuse between the first and second UDT were highest for those tested at the shortest intervals: approximately weekly, 19 percent; monthly, 15 percent; bimonthly, 12 percent; quarterly, 9 percent; semiannually, 3 percent; misuse rates increased by 1 percent for patients tested annually. Declines in misuse were more pronounced for opioids than other drug groups. Substantial declines in positivity were noted for heroin (32 percent) and nonprescribed fentanyl (10 percent). Declines in misuse between the second and third UDT followed a similar pattern.Conclusions: UDT intervals of ≤ quarterly were associated with marked declines, but testing annually or semiannually was not associated with consistent decreases. Our findings suggest that clinical strategies that include serial testing conducted quarterly or sooner may be instrumental in decreasing drug misuse. Testing more frequently than “at least once annually” should be considered by clinicians monitoring potential drug misuse.

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DRUG MISUSE AMONG THE ELDERLY

Journal of Gerontological Nursing ◽

10.3928/0098-9134-19781101-04 ◽

1978 ◽

Vol 4 (6) ◽

pp. 11-14 ◽

Cited By ~ 4

Author(s):

Joanne Olson ◽

Judith Johnson

Keyword(s):

The Elderly ◽

Drug Misuse

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Structural Antecedents of Psychoactive Drug Use Among the Elderly

Ageing and Society ◽

10.1017/s0144686x00009193 ◽

1982 ◽

Vol 2 (1) ◽

pp. 77-94 ◽

Cited By ~ 2

Author(s):

Brent Green

Keyword(s):

Drug Use ◽

Elderly People ◽

Current Literature ◽

Conceptual Analysis ◽

The Elderly ◽

Psychoactive Drug ◽

Drug Misuse ◽

Psychoactive Drugs ◽

Internal Colonialism ◽

Drug Experience

ABSTRACTCurrent literature on the over use of psychoactive drugs by elderly people suggests that alienation, poverty, rolelessness and lack of drug experience in earlier life are principal causes. But these are mainly empirical observations which have not been ordered into any theoretical framework. In proposing the applicability of the concept of ‘internal colonialism’ as a mode of explanation, the paper presents a survey of drug use prevalence as a basis for later conceptual analysis. It is concluded that drug misuse is an institutionalized response which perpetuates dependency.

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Hypertension and Drug Adherence in the Elderly

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2020.00049 ◽

2020 ◽

Vol 7 ◽

Cited By ~ 2

Author(s):

Michel Burnier ◽

Erietta Polychronopoulou ◽

Gregoire Wuerzner

Keyword(s):

The Elderly ◽

Drug Adherence

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The Cost of Potentially Inappropriate Medications in Nursing Homes in West Occitanie

Pharmacy ◽

10.3390/pharmacy8010039 ◽

2020 ◽

Vol 8 (1) ◽

pp. 39

Author(s):

Marie Caucat ◽

Alice Zacarin ◽

Vanessa Rousseau ◽

Jean-Louis Montastruc ◽

Haleh Bagheri

Keyword(s):

Nursing Homes ◽

Drug Prescription ◽

The Elderly ◽

Care Homes ◽

Drug Misuse ◽

Potentially Inappropriate Medications ◽

Homes For The Elderly ◽

The Mean ◽

The Cost ◽

Mean Cost

Introduction: As of 2019, people older than 65 years represent 20% of the French population. Despite several guidelines suggesting to avoid potentially inappropriate medication (PIM) use in elderly, the prevalence of their prescription remains high (25%). Furthermore, PIM could lead to preventable adverse drug reactions (ADRs). The main objective of this study was to determine the direct cost of PIM in older persons living in residential care homes for the elderly (nursing homes). A secondary objective was to assess the potential impact of PIM deprescribing on drug-related health care costs. Methods: We undertook a multicenter, retrospective study in 19 care homes for the elderly including 1240 residents. The analysis of prescriptions was carried out according to the European EU(7) PIM list. The cost of each drug was estimated according to the French Medication Insurance database. Furthermore, patient’s comorbidities were studied using Charlson’s comorbidity index. In order to estimate the economic impact of PIM, we used the list of alternative appropriate drugs suggested by EU(7) PIM list and French National Health Authority. An incremental cost per patient was calculated by the difference in costs between PIMs and alternative drugs. Results: A total of 7768 lines of drug prescriptions were analyzed. The mean age was 87.6 ± 7.6 years. About 70% (n = 872) of residents received more than five drugs. We identified 959 residents (77.3%) with at least one PIM. The mean cost of PIM was 0.58 euros versus 0.48 euros for alternatives. PIM substitution by alternatives led to save 12 centimes/resident/day. The mean cost of prescription with PIM was 2.8 euros per resident per day (28% of the overall cost of prescription). According to these results, more than 25 million euros can be overall saved for aged persons living in nursing homes for the older people in France per year. Conclusion: The prevalence of PIMs among the elderly in nursing homes is high and leads to a significant cost. Deprescribing of these medications could decrease both drug misuse and cost of drug prescription. Further research is needed to estimate the overall cost of PIM exposure outcomes, taking into account the ADRs leading to hospitalization.

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Drug Misuse Among the Elderly: A Hidden Menace

Psychiatric Annals ◽

10.3928/0048-5713-19770301-09 ◽

1977 ◽

Vol 7 (3) ◽

pp. 95-99

Author(s):

Louis P Bozzetti ◽

James P MacMurray

Keyword(s):

The Elderly ◽

Drug Misuse

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