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TORONTO - The majority of Canadian seniors are taking multiple types of drugs and in some cases the intake is fairly substantial, a new report suggests.
Just under two-thirds of people 65 and older are taking five or more prescription drugs on an ongoing basis. Twenty per cent are taking 10 or more and six per cent of Canadians 65 and older are taking 15 or more prescription medications, said the study, released Thursday by the Canadian Institute for Health Information.
"With the aging of Canada's population, it is important to understand which drugs are being used most often by seniors and which account for the highest proportions of public drug program expenditure," said Jean-Marie Berthelot, vice-president of programs for the organization.
"This information helps to inform decisions about the future planning and delivery of public drug programs."
The study looked at drug use among more than one million seniors covered by public drug programs in six provinces from 2002 to 2008.
Not surprisingly, the most commonly used drugs are prescribed for the treatment of chronic conditions which plague people who live into their late 60s, 70s, 80s and beyond, especially cardiovascular problems such as high blood pressure and heart failure.
Experts in the study of aging said the findings don't necessarily suggest people in this age bracket are being overprescribed drugs.
"I think in general older people tend to take probably about three times as many medications as younger people do. And that's often because they have chronic medical conditions that need to be treated," said Dr. Paula Rochon, a geriatrician and vice-president of research for Women's College Hospital in Toronto.
Rochon has published several studies on the overuse of some sedating medications in long-term care facilities and has warned of the potential of medications to have cascading effects in seniors who take multiple drugs together. But she was not alarmed by what she saw in this study.
Inappropriate drug treatment doesn't just mean giving too many drugs - it is also inappropriate not to prescribe drugs to people who should be getting them, she said.
"I think this very much has to be viewed from an individual's perspective," said Rochon. "There should be no absolute rule here.
"And so if you don't require medication, you shouldn't be taking medication. But if you have a medical condition that requires therapy, then you should be on those therapies. And the challenge is finding the right balance and looking at what's the right combination for an individual person."
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 focuses on the care of the aged.
"It's not hard to get up to 10 drugs."
But both Gordon and Rochon said that it's important to keep an eye on how many drugs seniors are taking and re-evaluate regularly whether all are still needed.
"Things can change, situations can change. New things can be started (and) you need to know why," Rochon said.
"(But) people get left on therapies that may or may not be things that they really need," she added. "So it's really important to understand why therapies were started and to regularly re-evaluate if they still are needed."
She also suggested more research is needed to look at the impact of these medications in this population. Many drugs are brought to market based on studies of people who are younger and healthier than the people who end up taking them.
"But in the real world setting ... these drug therapies are being used by people who are often older and likely have multiple chronic medical conditions," Rochon said. "So we need to start understanding that complexity a lot more."
