1 in 5 seniors on risky meds; more in US South

More than 1 in 5 seniors with Medicare Advantage plans received a prescription for a potentially harmful "high risk medication" in 2009, according to a newly published analysis by Brown University public health researchers. The questionable prescriptions were significantly more common in the Southeast region of the country, as well as among women and people living in relatively poor areas.

The demographic trends in the analysis, based on Medicare data from more than 6 million patients, suggest that differences in the rates of prescription of about 110 medications deemed risky for the elderly cannot be explained merely by the individual circumstances of patients, said lead author Danya Qato, a pharmacist and doctoral candidate in Health Services Research at Brown.

"At the population level it is clear that there is a unique phenomenon occurring," said Qato, lead author of the paper published in the current edition of the Journal of General Internal Medicine. "While one can reason that it might be appropriate for a particular patient to be on a particular medication, with such a preponderance of use of high risk medications in some locations versus others, our results suggest that we cannot attribute this variation wholly to patient characteristics."

In the analysis, Qato and co-author Dr. Amal Trivedi, an assistant professor of Health Services, Policy and Practice at Brown and a hospitalist at the Providence VA Medical Center, found that 21.4 percent of the patients, or more than 1.3 million people, received at least one high-risk medication, for which there is often a safer substitute, and that 4.8 percent received at least two.

'Geography is destiny'

Residents of the South Atlantic, East South Central and West South Central regions of the country – an area stretching from parts of Texas to South Carolina – had a 10 to 12 percentage point higher risk of receiving potentially harmful prescriptions than people in New England, who had the lowest chance, the analysis found.

The trend persists at the finer resolution of "hospital-referral regions" or HRRs -the authors note. "The 20 lowest performing HRRs were all in the Southern region of the U.S. In contrast," they wrote in the journal. "Only one of the twenty highest performing HRRs was in the South."

Albany, Ga., had the highest rate of receipt of single high-risk prescriptions: 38.2 percent. Seniors in Alexandria, La., led the nation in receiving at least two high-risk prescriptions, with a rate of 13.5 percent. Mason City, Iowa (9.6%) and Worcester, Mass. (0.7%), had the best rate of single and multiple high-risk prescription use, respectively.

In another demographic analysis, women across the country had a 10 percentage-point greater likelihood of receiving a high risk prescription. Other differences were less stark. Generally the lower the socioeconomic status of a patient's region, the more likely they were to receive a high-risk medication. Residents of the poorest areas had a 2.7 percentage point higher risk than the residents of the richest areas.