Half of Older Patients on NSAIDs, Opioids, Other Medications Don’t Need Them: Study

Read about the alarming trend of inappropriate prescribing for the elderly.

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Are you or a loved one over 65 and taking multiple medications?

Many seniors may be prescribed drugs they don’t actually need, putting their health at risk, according to a new study.

Researchers from Croatia found that a half of the nearly 400 older adults surveyed were candidates for “deprescribing”—stopping or reducing the use of certain medications that could be doing more harm than good.

The culprits? Proton pump inhibitors, non-steroidal anti-inflammatory drugs (NSAIDs), opioid painkillers, and sedatives like benzodiazepines. “The high rate of deprescribing potential warrants prompt action to increase patient safety and decrease polypharmacy,” the authors wrote, sounding the alarm on a silent epidemic of overprescription that could be jeopardizing the well-being of millions of older people.

The Trifecta of Overprescription in Seniors

The research team analyzed data from 388 patients aged 65 and older who were part of the EuroAgeism H2020 ESR 7 international project, and international multi-disciplinary project.

The patients were in stable health, used at least one medication, and did not have severe communication disorders or dementia. The data was collected through interviews with pharmacists, lasting between 45 and 75 minutes.

Nearly one-third of all participants used a proton pump inhibitor, while 40 percent were taking a benzodiazepine receptor agonists. Just under 30 percent of participants were on NSAIDs, and 15.5 percent were taking opioid analgesics.

• Proton pump inhibitors: Prescribed to relieve symptoms related to acid reflux or gastroesophageal reflux disease (GERD). They also treat duodenal or stomach ulcers and damage to the lower esophagus caused by acid reflux.
• Benzodiazepine receptor agonists: Sedative drugs prescribed to treat insomnia and anxiety. They are often prescribed for long-term use.
• Opioid analgesics and NSAIDs: Prescribed to manage and treat acute pain, although opioids are stronger.

The most commonly combined medications were proton pump inhibitors and benzodiazepine receptor agonists, with 8.2 percent of participants taking both. Slightly under 6 percent of participants took both NSAIDs and benzodiazepine receptor agonists. Only three participants used all four types of medications simultaneously.

Medication Mismanagement

According to the deprescribing criteria, patients should be taken off a medication if there is a lack of indication (when there is no specific recommendation for a particular drug for a specific condition), if it has been used for too long, if the dosing is inappropriate, or if there are concerns about the dosing.

Based on the deprescribing criteria, more than half of the patients were candidates for deprescribing, with 33.5 percent meeting the criteria for one medication, 18.8 percent meeting the criteria for two medications, and 3.4 percent meeting the criteria for three medications.

Specifically, 31.1 percent of participants taking proton pump inhibitors met the criteria for deprescribing, 74.8 percent of NSAID users met the criteria, 75 percent of opioid users met the criteria, and 96.1 percent of benzodiazepine users met the criteria for deprescribing.

The most common criterion for deprescribing was inappropriately long use, followed by safety concerns, and lack of indication, according to the research team.

Prioritizing Patient Safety

The overprescription of opioids has been a longstanding issue.

A July 2023 study notes that overprescribing opioids and opiates is a significant factor contributing to America’s opioid dependence epidemic. The U.S. has the highest rate of opioid consumption per capita, as well as the highest number of opioid-related deaths. “Pharmaceutical companies that produce the drugs, the pharmacies that distribute prescription drugs, and the doctors who prescribe them all share the blame for the opioid crisis,” the authors wrote.

The Croatian research team noted that deprescribing medications would have a positive impact on patients, including improving their mental health and overall functional abilities.

“Timely action towards reducing the use of commonly prescribed potentially inappropriate medications is needed to increase patient safety and contribute to healthy ageing,” the research team noted.

Personalized medication management can be facilitated by having pharmacists conduct comprehensive assessments focused on the elderly population and reviews specifically aimed at identifying medications that could potentially be deprescribed.