Tuesday, February 14, 2017

Rural areas lead older Americans' increasing use of drugs that alter the user's mental state

Researchers have found that "the number of retirement-age Americans taking at least three psychiatric drugs more than doubled between 2004 and 2013, even though almost half of them had no mental-health diagnosis on record," Benedict Carey reports for The New York Times.

"The biggest jump was in rural areas," which suggests "that the increases partly reflect doctors and patients falling back on medications when they have little access to other options," Dr. Mark Olfson of Columbia University, and a member of the research team, told Carey. In rural areas, there is little access to "talk therapy, massage or relaxation techniques."
Tablets of antidepressants
(Getty Images photo by Jonathan Nourok)

The paper, which appeared in the journal JAMA Internal Medicine, says "Inappropriate prescribing to older people is more common than previously thought. Office visits are a close, if not exact, estimate of underlying patient numbers," Carey writes. Geriatric medical organizations have warned against over-prescribing to older people, arguing that they are more susceptible to common side effects, Carey writes. "For more than 20 years, the American Geriatrics Society has published the so-called Beers Criteria for potentially inappropriate use, listing dozens of drugs and their mutual interactions."

Despite the reports over the years, prescription rates of drugs like antidepressants, sleeping pills and painkillers have generally increased in older people, Carey writes. The new report, however, "captures one important dimension, the rise in so-called polypharmacy — three drugs or more — in primary care, where most of the prescribing happens. Earlier research has found that elderly people are more likely to be on at least one psychiatric drug long term than younger adults, even though the incidence of most mental disorders declines later in life."

The data analyzed "office visits by people 65 or older that resulted in the prescribing of at least three of a list of psychiatric, sleep and pain medications like Valium, Prozac, OxyContin and Ambien. The study found that "nearly 46 percent of people with at least three prescriptions had no diagnosis of a mood, chronic pain or sleep problem," Carey writes.

Olfson told Carey that one possible solution "would be to give patients and doctors greater access to alternatives, like psychotherapy and stress management. Only about 10 percent of the visits in the analysis included one of these options."

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