The FDA researchers and colleagues noted that from 1999–2000 through 2005–2006, any medication used by patients aged 65 years and older increased from 83.9% to 90.0%, with little change in usage from then to the present.
“Aging of the US population and increasingly common chronic conditions have led to growing reliance on the use of prescription medications,” the study team wrote in a research letter published in the Journal of the American Medical Association Internal Medicine. “Understanding patterns of medication use can guide prescribing practices and strategies to enhance appropriate use.”
The researchers sought to investigate trends in prescription medication use and the top 10 most-used medication classes among adults aged 65 years or older in the United States from January 1999 to March 2020.
To do that, they analyzed data from the National Health and Nutrition Examination Surveys (NHANES), which uses a cross-sectional design with multistage probability sampling to examine a nationally representative sample of noninstitutionalized U.S. civilians.
The data included 14,917 adults aged 65 years or older with available medication information. The study only considered prescription medications used within the past 30 days. Those were validated through inspection of medication containers or pharmacy printouts.
For purposes of the study, polypharmacy was defined as using five or more medications and hyperpolypharmacy as using 10 or more medications.
The results indicated that polypharmacy increased from 1999–2000 to 2003–2004 from 23.6% (95% CI, 20.9%-26.5%) to 35.9% (95% CI, 32.7%-39.7%; P = .01), and it peaked at 43.0% (95% CI, 40.0%-46.6%) from 2017 to March 2020 (P = .02). The researchers reported that from 1999–2000 through 2007–2008, hyperpolypharmacy increased from 1.8% (95% CI, 0.1%-3.0%) to 6.1% (95% CI, 4.3%-8.4%; P <.001).
At the same time, the use of potentially inappropriate medications (PIMs) as defined by the 2023 Beers Criteria decreased from 48.8% (95% CI, 45.8%-51.7%) to 44.6% (95% CI, 41.2%-48.1%; P <.001).
The report pointed out that among the top 10 most used Level 1 medication classes, five increased over time: cardiovascular, coagulation, gastrointestinal, metabolic, and psychotherapeutic agents. “Within the second-level medication classification, 6 of the top 10 were cardiovascular agents, of which 3 increased,” according to the authors.
“During the same period, chronic conditions, such as diabetes and multimorbidity, increased, while at the same time, adverse drug events increased,” the researchers advised. “Medications are crucial for managing illnesses and saving lives but contain risks. Understanding medication patterns can inform prescribing practices to reduce adverse drug events risk and unnecessary polypharmacy, hyper-polypharmacy, and PIMs.”
One of the limitations of the study is that NHANES had a decreasing response rate among participants aged 60 years or older from 73.9% in 1999–2000 to 46.5% from 2017–March 2020. Also, older adults living in healthcare facilities are unrepresented. In addition, no OTC medications were included in this analysis.
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