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Prescribing medications for your older adult patients
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When you prescribe a new medication to adults age 65 and older, please keep in
mind that many medications have a greater potential for side effects. Patients
in this age group are twice as likely as those younger than age 65 to
experience adverse drug events ? and almost seven times as likely to be
hospitalized from them.
The Centers for Medicare & Medicaid Services (CMS) has developed performance
and quality measures to help Medicare beneficiaries make informed decisions
regarding health and prescription drug plans. As part of this effort, CMS has
developed a rating system to rank medications based on the risks of side
effects in older adults. This is known as the HRM (high-risk medication) rate.
Below are just a few of the more common HRMs:
carisoprodol (Soma[]?[])
cyclobenzaprine (Flexeril[]?[])
diazepam (Valium[]?[])
dicyclomine (Bentyl[]?[])
diphenoxylate-atropine (Lomotil[]?[])
estrogens (Premarin[]?[])
hydroxyzine (Atarax[]?[] or Vistaril[]?[])
hyoscyamine (Levsin[]?[])
nitrofurantoin (Macrobid[]?[] or Macrodantin[]?[])
promethazine-codeine (Phenergan[]?[] with codeine)
A complete list of HRMs from the National Committee for Quality Assurance
(NCQA) is available at www.ncqa.org/
Portals/0/Newsroom/SOHC/Drugs_Avoided_Elderly.pdf. According to CMS, the drugs
included on the list should be avoided or used with caution in older adults.
Some of these drugs simply are not effective enough to be routinely used or
are no longer recommended because newer, safer alternatives are now available.
The list is based on the "Beers List," which is an internationally recognized
list of drugs that may be inappropriate for use in the elderly due to the
potential risk of adverse events.
There is an even greater risk when a patient is on more than one medication
considered an HRM. Careful and appropriate use of drugs in the senior
population is a critical quality-of-care issue. For these reasons, we suggest
that you use caution when prescribing one or more drugs on the NCQA list to
patients age 65 and older.