Seniors take 5 drugs or more: study

Almost two-thirds of Canadian seniors in six provinces are taking five or more types of prescription drugs, according to a new report.

The Canadian Institute for Health Information's study, covering the years 2002 to 2008, looked at public drug claims for more than one million people aged 65 or older in Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia and Prince Edward Island.

In 2008, 21 per cent of the seniors were using 10 or more types of prescription drugs and six per cent took 15 or more different classes of drugs.

The information is important since seniors account for the highest proportion of spending by public drug programs in Canada, the report's authors noted.

Potential drug interactions

Drugs for chronic illnesses such as cardiovascular conditions, including high blood pressure, high cholesterol and heart failure, were the most commonly used class of drugs for seniors younger than 85.

Multiple drugs are often needed to manage chronic conditions effectively, but it's important to consider the potential risks, including adverse effects and interactions, said Dr. Angela Juby, an associate professor in geriatric medicine at the University of Alberta in Edmonton.

While prescribing five drugs would have been considerate inappropriate 20 years ago, that is now the norm for seniors, said Prof. Steve Morgan of the School of Population and Public Health at the University of British Columbia's Centre for Health Services and Policy Research.

Like Juby, Morgan also raised questions about "polypharmacy," given that Canadian doctors don't have ready access to electronic health records and prescription records that could flag potential interactions when writing a new prescription. The latest figures don't include over-the-counter drugs.

Medication check ups

Dr. Michael Gordon noted that people with angina — recurring chest pain — who have had a heart attack would probably be taking a beta blocker, Aspirin, nitroglycerin, a calcium channel blocker, an ACE inhibitor and maybe a diuretic.

"That's five, six drugs — for one organ, and you haven't even talked about your knees," said Gordon, a geriatrician at Baycrest, an academic health sciences centre in Toronto that specializes in the elderly. "It's not hard to get up to 10 drugs."

Seniors should keep an eye on what medications they are taking and why as their situation changes, Morgan and geriatricians said. A good way to keep track is to bring in all one's medications once a year and have family doctors or pharmacists review what's prescribed by all practitioners to see whether the combinations make sense.

Generic savings to come

Morgan noted that blockbuster drugs such as cholesterol-lowering statins like Lipitor are coming off patent by 2013. Those drugs are worth $100 billion worldwide in global sales over five years, he said.

"If you're paying for it out of your pocket, you should soon be able to get it cheaper, because it's becoming generic," said Morgan, a policy adviser for the report. Likewise, public and private insurers should expect savings from generics.

Among public drug program expenditures:

• The highest amount was for statins, accounting for 14 per cent of total program spending on seniors.
• Proton pump inhibitors, used for acid reflux, took up seven per cent of total spending.
• Dihydropyridine calcium channel blockers, used for high blood pressure, also accounted for seven per cent of total spending.

The drug class that showed the fastest growth in spending over the study period was tumour necrosis factor alpha inhibitors (anti-TNF drugs, such as etanercept), which treat conditions such as rheumatoid arthritis and Crohn's disease.

Total drug spending on this class of drugs increased by an average of 58 per cent annually from 2002 to 2008 and accounted for two per cent of total program spending on seniors in 2008.

The report did not look at expensive new cancer drugs. But Morgan said if provincial drug plans for seniors could realize savings from generics for common chronic conditions, particularly through a national purchasing strategy, they could better address the challenges of cancer and rarer ailments.