Target Audience (click to view)
This activity is designed to meet the needs of physicians and nurses.
Learning Objectives(click to view)
Upon completion of the educational activity, participants should be able to:
- Review the need for, and results of, a study that sought—using 2010-2011 data—to update estimates of medication use, concurrent use, and drug-drug interactions among older adults throughout the United States and explored if there were any changes in risks of drug-drug interactions since the last time data was collected in 2005-2006.
Method of Participation(click to view)
Release Date: 4/13/17
Expiration Date: 4/13/2018
Statements of credit will be awarded based on the participant reviewing monograph, correctly answer 2 out of 3 questions on the post test, completing and submitting an activity evaluation. A statement of credit will be available upon completion of an online evaluation/claimed credit form at akhcme.com/akhcme/lessons/36. You must participate in the entire activity to receive credit. If you have questions about this CME/CE activity, please contact AKH Inc. firstname.lastname@example.org.
Credit Available(click to view)
CME Credit Provided by AKH Inc., Advancing Knowledge in Healthcare
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AKH Inc., Advancing Knowledge in Healthcare and Physician’s Weekly’s. AKH Inc., Advancing Knowledge in Healthcare is accredited by the ACCME to provide continuing medical education for physicians.
AKH Inc., Advancing Knowledge in Healthcare designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
NCCPA accepts AMA PRA Category 1 Credit™ from organizations accredited by ACCME.
AKH Inc., Advancing Knowledge in Healthcare is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.
This activity is awarded 0.5 contact hours.
Commercial Support(click to view)
There is no commercial support for this activity.
Disclosures(click to view)
It is the policy of AKH Inc. to ensure independence, balance, objectivity, scientific rigor, and integrity in all of its continuing education activities. The author must disclose to the participants any significant relationships with commercial interests whose products or devices may be mentioned in the activity or with the commercial supporter of this continuing education activity. Identified conflicts of interest are resolved by AKH prior to accreditation of the activity and may include any of or combination of the following: attestation to non-commercial content; notification of independent and certified CME/CE expectations; referral to National Author Initiative training; restriction of topic area or content; restriction to discussion of science only; amendment of content to eliminate discussion of device or technique; use of other author for discussion of recommendations; independent review against criteria ensuring evidence support recommendation; moderator review; and peer review.
Disclosure of Unlabeled Use & Investigational Product(click to view)
This educational activity may include discussion of uses of agents that are investigational and/or unapproved by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Disclaimer(click to view)
This course is designed solely to provide the healthcare professional with information to assist in his/her practice and professional development and is not to be considered a diagnostic tool to replace professional advice or treatment. The course serves as a general guide to the healthcare professional, and therefore, cannot be considered as giving legal, nursing, medical, or other professional advice in specific cases. AKH Inc. specifically disclaim responsibility for any adverse consequences resulting directly or indirectly from information in the course, for undetected error, or through participant’s misunderstanding of the content.
Faculty & Credentials(click to view)
Chris Cole – Managing Editor
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
Dima M. Qato, PharmD, MPH, PhD
Discloses no financial relationships with pharmaceutical or medical product manufacturers
AKH and PHYSICIAN WEEKLY’S STAFF/REVIEWERS
Dorothy Caputo, MA, BSN, RN- CE Director of Accreditation
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
AKH planners and reviewers have no relevant financial relationships to disclose.
Complete the Post Test(click to view)
Published research indicates that many older adults in the United States use prescription and over-the-counter (OTC) medications and dietary supplements, but this can increase their risks for polypharmacy and adverse drug events. Many medications that are commonly used by older adults, such as antiplatelets, anticoagulants, statins, and NSAIDs, are associated with serious drug-drug interactions, which may further increase this risk.
Previously, investigators have examined the use of prescription and OTC medications and dietary supplements among older adults in the U.S. These studies have revealed that more than half of older adults concurrently use prescription and nonprescription medications, including dietary supplements. “A significant number of older adults use interacting medications or dietary supplements that can potentially increase their risks for adverse drug events,” explains Dima M. Qato, PharmD, MPH, PhD.
With new drugs continuing to emerge on the market and the increasing availability of generic and OTC products, it is becoming even more important to examine the potential safety concerns associated with commonly used drugs among older adults. Recently collected data may underestimate medication use and potential adverse effects because they do not always capture information on OTC medications and dietary supplements.
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- Dietary supplement interactions with antiretrovirals: a systematic review
A Closer Look
For a study published in JAMA Internal Medicine, Dr. Qato and colleagues examined nationally representative data from the second wave of the National Social Life, Health, and Aging Project, which included data from 2010-2011. The study sought to update estimates of medication use, concurrent use, and drug-drug interactions among older adults throughout the country and explored if there were any changes in risks of drug-drug interactions since the last time data was collected in 2005-2006. The total study cohort consisted of 2,351 participants in 2005-2006 and 2,206 in 2010-2011.
Results of the analysis showed that the rate of older adults using at least one prescription medication increased slightly from 84.1% in 2005-2006 to 87.7% in 2010-2011. Concurrent use of at least five prescription medications increased from 30.6% to 35.8% between the cohorts. Use of OTC medications declined from 44.4% to 37.9%, but use of dietary supplements increased from 51.8% to 63.7% during the study period.
The study also showed that there were clinically significant increases in the use of statins, antiplatelets, and omega-3 fish oils during the study period. In 2010-2011, about 15.1% of older adults were at risk for a potential major drug-drug interaction, compared with a rate of about 8.4% that was seen in the 2005-2006 cohort (Table). Most of these interacting regimens involved medications and dietary supplements that were increasingly used in patients in 2010-2011. The study team reported that older adults nearly doubled their use of multiple medications and dietary supplements from 2005-2006 to 2010-2011. About one in six older adults may be at risk for a major drug-drug interaction.
Analyzing Commonly Used Drugs
Authors of the study also identified 93 potential drug-drug interactions that involved prescription and OTC medications and supplements based on the 20 most commonly used medications and 20 of the most commonly used supplements. Among these products, 15 interacting combinations were classified as being a potentially major or life-threatening. Each of these products was reportedly used by at least one respondent in the study sample. Several factors may have contributed to the results, such as the implementation of Medicare Part D, changes to clinical guidelines, and changing market dynamics, such as new therapies being brought to market and patents expiring.
A Growing Health Issue
According to Dr. Qato, findings from the study suggest that the unsafe use of multiple drugs among older adults is a growing public health problem. “Physicians and healthcare professionals should carefully consider the adverse effects of commonly used prescription and nonprescription medication combinations when treating and counseling older adults,” she says. “Efforts are needed to regularly monitor patients for all of the drugs they take rather than just prescription medications. Patients also need to be counseled about potential risks they can incur by using multiple drugs. This is a critical patient safety issue that needs to be dealt with proactively.”
By focusing on improving the safe use of multiple medications, physicians can potentially help reduce preventable adverse drug events that have been linked to drugs that are commonly and increasingly used among older American adults, according to Dr. Qato. “Clinicians need to become more aware of this issue and think about the risks that are associated with concurrent use of interacting medications,” she says. “These efforts may include incorporating the interaction effects of commonly used medications—including OTC medications and dietary supplements—in treatment guidelines.”
Readings & Resources (click to view)
Qato DM, Wilder J, Schumm LP, Gillet V, Alexander GC. Changes in prescription and over-the-counter medication and dietary supplement use among older adults in the United States, 2005 vs 2011. JAMA Intern Med. 2016;176:473-482. Available at: http://archinte.jamanetwork.com/article.aspx?articleid=2500064.
Qato DM, Alexander GC, Conti RM, Johnson M, Schumm P, Lindau ST. Use of prescription and over-the-counter medications and dietary supplements among older adults in the United States. JAMA. 2008;300:2867-2878.
Hilmer SN, Gnjidic D. The effects of polypharmacy in older adults. Clin Pharmacol Ther. 2009;85:86-88.
Gu Q, Dillon CF, Burt VL. Prescription drug use continues to increase: U.S. prescription drug data for 2007-2008. NCHS Data Brief. 2010;42:1-8.