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the long view

In the UBC study, the medications most likely to be inappropriately prescribed were benzodiazepines (tranquilizers).

If you are over 65, there's a good chance you shouldn't be taking at least one of your medications – especially if you are a woman.

More than a quarter of people between the ages of 65 and 74 receive inappropriate medications, a study from the University of British Columbia has found. But women are much more likely than men to be prescribed drugs that older patients should avoid.

Even after accounting for differences in patients' income, ethnicity, health and marital status, "we still found that being a woman elevated the risk of receiving these inappropriate prescriptions by between 16 and 23 per cent," said Steve Morgan, the study's principal investigator and a professor in UBC's school of population and public health.

In the UBC study, the medications most likely to be inappropriately prescribed were benzodiazepines (tranquilizers such as Valium and Xanax). Others included nifedipine (a cardiovascular drug used to manage angina and high blood pressure) and tetracyclic antidepressants (an older class of antidepressants).

Since physiology and the way we metabolize drugs change with age, medications suitable for younger adults may be riskier for seniors, Morgan said.

Benzodiazepines, used to treat anxiety and insomnia, cause dizziness and increase the risk of falls in older adults. "And they're habit forming – people have difficulty getting off them."

Guidelines suggest that patients should not take benzodiazepines for more than 30 to 60 days. But in the study, 13 per cent of women over 65 had filled those prescriptions for 90 days or more, compared with 8.4 per cent of men.

That does not necessarily mean that doctors treat older women differently. Morgan noted that women are more likely to seek medical attention for anxiety and sleeplessness, whereas men are more likely to self-medicate with alcohol and other drugs, according to previous research.

Overuse of tranquilizers in both sexes may stem from long-term prescription renewals, he said. "We suspect that many people actually started using them 10 or 15, or maybe 20 years earlier, when they were middle-aged."

Previous studies suggest that doctors feel pressure to give in to patients' requests for prescription renewals, or are wary of changing medications originally prescribed by a specialist.

Patients should not go off tranquilizers cold turkey, Morgan said. Weaning patients off of these medications usually involves prescribing lower dosages over time and offering alternatives such as psychotherapy, mindfulness training and peer support. The Canadian Deprescribing Network, made up of researchers and patients groups, is working to develop health-care policies that would encourage doctors and patients to take these steps. Right now, he said, "there aren't that many resources to help health-care providers get paid to do this work."

The study, published this month in the medical journal Age and Ageing, analyzed population-based data from British Columbia's PharmaNet, a province-wide network that links B.C. pharmacies to central databases.

Rates of inappropriate prescribing for older adults are similarly high in other parts of the country, according to a 2012 study conducted by the Canadian Institute For Health Information.

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