Q& A

Dr. Mark Beers led a team of 12 experts in drafting the Beers list, identifying which drugs posed higher risks to seniors. (Nati Harnik/Associated Press)

Dr. Mark Beers on how prescribing patterns have changed since he launched the Beers List in 1991 and how seniors are still taking high-risk drugs - and suffering adverse reactions. Beers spoke to CBCNews.ca Thursday from Philadelphia, PA.

Since you originally created the Beers list in 1991, has it changed doctors' prescribing habits?

Yes, I think it really has. One of the things doctors respond very well to is really explicit information and we work very hard to tell them the principles of prescribing to the elderly - by giving them specific examples and continuing feedback. This Canadian study that's out shows a substantial decrease in the use of these medications. I couldn't be more pleased with the effect [the list has] had on improving prescribing.

Since you launched the report, has there been a steady decline in Beers drugs being used among seniors?

Yes, there's been a steady decline and I think there are a number of factors. Many of these drugs are simply older drugs and they've gone out of fashion. The drug companies have created better drugs for the elderly and have marketed them and that's a good thing in many ways. Also, [there's been an] application of the criteria in research, teaching (they're used in most medical schools now), a lot of websites and in textbooks. So part of it is attributable to the Beers criteria, part of it is attributable just to the changing world and a better formulary for older patients.

What makes seniors particularly vulnerable to adverse reactions?

Well there are a number of things. One is the sheer quantity of drugs that they use, so that there are drug-drug interactions. There are drug-disease interactions, and the elderly have a lot of concomitant illnesses. But there are basic pharmacological changes that happen when we age, it's the way the liver is able to metabolize many drugs, the way the kidney are able to excrete many drugs and the way the body responds to medication. We have a great deal of information on all of those fronts so that we can define which medications are most likely to cause problems in the elderly.

Would you say that pharmacists are also aware of these types of changes?

Yes, and the pharmacy world has put a great deal of effort in improving prescribing to the elderly. There's an organization called the American Society of Consultant Pharmacists that specializes in senior care pharmacy and they do huge educational efforts for pharmacists on training them on the special needs of the elderly, not just the physiological changes but even some of the sociological issues like how to write proper directions for the elderly, how to package pills correctly and how to look for those special problems.

They really are an intrinsic part of the health-care team in providing medications and whether it's an outpatient pharmacy, a mail-order pharmacy or the pharmacist in an institution like a nursing home or a hospital, there's a huge amount of power and responsibility on the part of the pharmacist to do exactly that.

In terms of the findings coming out today from the CIHI report, are you fairly encouraged by these results?

I'm encouraged on a number of fronts. There's been a large reduction in the use of these medications. The numbers are still too high and some of the provinces are still finding 25 per cent of people are getting one of these medications -- so I don't think we are out of the woods yet.

Certain drugs considered high risk on your list have increased slightly between 2004 and 2006.

That's right and that's frightening. Our panelists did rate these drugs as ordinary problems or high-risk problems and there was a slight increase in the use of some of those higher-risk drugs. That has worsened. It's not a huge increase but it's something to pay attention to. And you can also see there's a difference among the provinces of Canada there are geographical patterns that are showing us that we have to do more work in some parts of this country.

There's a need for more work among the provinces to iron out some of those inconsistencies?

That's exactly right, you see they have these wonderful provincial databases that allows Canada to look at things on the basis of the province so they can target more accurately where their needs might be. And I'm hopeful that this report will be used to do exactly that: put the attention where it's most needed.

There was also an interesting finding that women are using more Beers list drugs than men.

We know that women tend to be given more drugs in general, but it was an interesting finding. It's probably because women tend to receive more psychoactive medications. They also have more arthritis and some of the drugs in the categories are more likely to be prescribed to women. I don't think that anybody is targeting women with these drugs, it's simply that they have the kinds of conditions for which some of these medications are frequently used.

Are there any particular drugs that you personally feel shouldn't be prescribed?

I have a few pet peeves indeed. There's a painkiller called Darvon propoxyphene that's a very inadequate painkiller and yet it's a narcotic and therefore gives all of the side effects and problems of narcotics without the really large benefit that narcotics can provide when pain relief is needed. It's a drug that is no more effective than Tylenol in controlling pain and yet has a great deal more side effects. It is too widely used.

Going forward, how can adverse reactions be curbed further?

I think it's a two-fold process, one is better education of prescribers and by prescribers I mean prescribers and pharmacists, the entire team, nurses as well. But also I think we have to do more in educating the general public to question the medications they're receiving and being prescribed and to review them with their doctors and pharmacists and say, "I'm 80 years old now, I've been taking this medication for a long time, is this a safe drug for me and is this the best drug for me?"

When prescribers are questioned like that they do their homework and they check them. Family members and patients themselves really need to become involved in their own care. In this busy world where we don't give people the kind of time they need, it's really important that people remain their own advocate.

I think the baby boomers are going to be more involved in their own care than the current generation of seniors and that's going to be a very good thing.