Geriatrician Care Guards Against Risk of Inappropriate Meds

FRIDAY Jan. 25, 2008 -- Elderly Americans taking prescription medications face a lower risk for being given an inappropriate drug or dosage if they receive care from a geriatrician, new research reveals.

The finding is based on a large, national review of mostly male veterans who sought care at VA facilities across the United States.

The analysis indicates that roughly one in four vets were inappropriately prescribed medications, while those few who had visited with a geriatrician in the past year had reduced exposure to such critical mistakes.

"Geriatric care seems to help protect patients who are receiving prescription medications," said study author Mary Jo V. Pugh, a research health scientist with the South Texas Veterans Health Care System, and an assistant professor at the University of Texas Health Science Center at San Antonio.

"And we think this may be about more than just the individual's decision to see a geriatrician but also about the hospital culture regarding elderly care itself," she added.

The study, published in the February issue of Medical Care, is a review of data concerning more than 850,000 veterans over the age of 65 who had sought outpatient care at one of 124 VA facilities between 1999 and 2000.

Most of the VA centers were teaching hospitals in urban areas. More than two-thirds of the patients were white, almost all were male, and all had been prescribed an oral, topical, or injectable medication in 2000.

Using what they said is the most commonly accepted criteria for "inappropriate" prescribing, the researchers reviewed incidents in which drugs were prescribed for too long a period of time, for the wrong diagnosis, in incorrect amounts, or for patients of the wrong age.

They found that a little more than 26 percent of the patients had been improperly prescribed medication, either by dosage or type.

However, the 3 percent of patients who received some degree of care from a geriatrician in the prior year were less likely to be inappropriately prescribed.

Such patients were more likely to be white, older, coping with more physical and/or mental health issues, and following a broader prescription drug regimen, the authors observed.

Yet, Pugh and her colleagues cautioned that simply visiting with an elderly care specialist might not offer equal protection to all patients.

They noted that those getting geriatric care in VA settings, where few patients were treated by geriatricians, appeared to face a higher risk for medication mishaps, relative to elderly patients seeing geriatric or non-geriatric care at facilities with a larger overall percentage of geriatrician-treated patients.

The authors stressed, however, that much more research is needed to determine how clearly prescription risk is affected by a facility's patient profile or geriatric system set-up.

"Meanwhile, we need to reevaluate the kind of care we provide to older patients," said Pugh. "And we need to train more geriatricians, because part of the problem is that there aren't a lot of geriatricians in the U.S., and we're not going to have enough to handle all the patients' needs as the baby boomers come into the system."

Dr. James S. Goodwin, director of the Sealy Center on Aging and a geriatrics professor at the University of Texas Medical Branch at Galveston, agreed.

"The number of geriatricians has decreased over the past 10 years, at a time when we are going to need more," he noted. "And that is because consulting with a geriatrician is extremely valuable, in that patients tend to accumulate medicines as they grow older, and a geriatrician will come to a first meeting with a bias to discover those drugs that the patient no longer needs. So, you get an important and comprehensive medicine review."

More information

To learn more, visit the American Geriatrics Society.

Posted: January 2008


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