Take a peek into your grandma's medicine cabinet: It may well be bursting at the seams.
A new study shows that almost two-thirds of Canadians over the age of 65 are taking five or more prescription medications.
That includes one in five seniors who are taking 10 or more drugs and one in 20 seniors who are taking a staggering 15 or more meds to manage a variety of conditions, from high blood pressure through to Alzheimer's, according to data from the Canadian Institute for Health Information.
"There some cause for alarm in that we see polypharmacy - or multiple medications - becoming the norm," Steve Morgan, associate director of the Centre for Health Services and Policy Research at the University of British Columbia, said in an interview.
"Five or more drugs used to be a sign of inappropriate prescribing, but times have obviously changed," he said.
Dr. Morgan, who was not involved in the research, emphasized that the data do not indicate whether the prescriptions for individuals are appropriate or not.
His underlying concerns are that prescription drugs are rarely tested on seniors, that multiple medications greatly increase the risk of dangerous drug interactions, and that there is little co-ordination of care and tracking of prescription drugs, in large part because electronic health records are a rarity in Canada.
"Many doctors who are prescribing drug number 10 have no idea what the other nine drugs are," Dr. Morgan said.
Canadians spent $25.2-billion on prescription drugs in 2008, the most recent year for which detailed data are available. That includes $14-billion in private spending (private drug plans and out-of-pocket) and $11.2-billion in public spending.
It is unclear what proportion of spending is related to seniors. However, every province and territory has a publicly funded prescription-drug insurance program for those over the age of 65.
The new study was designed to show which drugs are used most often by seniors, and which account for the highest proportion of public spending. The data were culled from drug plans in six provinces that include about one million of Canada's 4.5 million seniors.
Michael Gaucher, manager of pharmaceuticals at CIHI, said, not surprisingly, the most commonly used drug classes treat chronic conditions, and cardiovascular disease in particular.
Statins, used to treat high cholesterol, are the drugs most commonly prescribed to seniors; they are prescribed to almost 40 per cent of people over the age of 65. Next are angiotensin-converting enzyme (ACE) inhibitors, used to treat high blood pressure, at 27 per cent, and proton pump inhibitors (PPIs), which are used to treat gastro-esophageal reflex disease (GERD), at 21 per cent.
Statins account for 14 per cent of all drug spending, followed by PPIs and calcium channel blockers, another type of drug used to treat high blood pressure, at seven per cent each.
One of the aspects of the report of greatest interest to policy-makers is the examination of the fastest-growing drug classes, because they will place the greatest pressure on drug budgets in coming years.
They include tumour necrosis factor alpha inhibitors (anti-TNF) for the treatment of rheumatoid arthritis, anticholinergics for the treatment of chronic obstructive pulmonary disease and anticholinesterases for the treatment of Alzheimer disease.
Spending on anti-TNF drugs, for example, has increased by an average of almost 60 per cent annually over the past six years.
Conversely, spending has decreased significantly for several classes of drugs in recent years, largely due to safety concerns. Coxibs, a class of painkillers that includes Vioxx was linked to heart disease and hormone replacement therapy, a once-popular treatment for symptoms of menopause linked to an increase risk of breast cancer and heart disease, both saw sharp drops. Use of H2 receptor antagonists, a treatment for GERD, has also dropped off with the advent of PPIs.
The public drug program data showed wide disparities among the six provinces studied. For example, average spending ranged from $875 per senior beneficiary in PEI to $1,632 in Manitoba.
It is notable too that almost half of all drug spending was for a small group of seniors, the 15 per cent who annual drug costs exceeded $2,500.
André Picard