May 17, 2018 — In 2016, about 1.6 million seniors (representing approximately 1 in 4 Canadians age 65 and older) were prescribed 10 or more drug classes, according to a new report by the Canadian Institute for Health Information (CIHI) that looks broadly at drug use among Canadian seniors.
A drug class is a group of chemicals that works in the same way to treat similar medical conditions. For example, opioids are a type of drug class commonly used to manage moderate to severe pain.
Seniors continue to be prescribed a large number of drugs, and this number increases with age. There was minimal change in the average number of drugs prescribed to seniors between 2011 and 2016.
Seniors who were prescribed 10+ drugs were more likely to be hospitalized for an adverse drug reaction — over 5 times more likely than seniors who were prescribed fewer drugs. Cancer drugs, opioids and blood thinners were the most common drug classes that led to hospitalizations for adverse drug reactions.
What drugs are prescribed?
In 2016, drugs used to treat high cholesterol — used by nearly half of all seniors — were the most commonly prescribed drug class. Other common drug classes prescribed included drugs for acid reflux disease, peptic ulcer disease and high blood pressure.
Potentially inappropriate drug use
Approximately 1.9 million Canadian seniors chronically used at least one potentially inappropriate drug in 2016, which is comparable with the 2011 rate. Chronic use is defined as a person who has at least 2 claims and 180 days’ supply of a drug.
Potentially inappropriate drugs can increase the risk of adverse effects, such as falls, fractures and mental impairment, and there are often safer alternatives. Commonly used drug classes such as proton pump inhibitors (used for acid reflux disease and peptic ulcer disease) and benzodiazepines (used for anxiety and insomnia) are among the drugs considered to be potentially inappropriate.
Drug use in seniors
Some of the report’s other findings include the following:
- Women (36.8%) had higher chronic use of potentially inappropriate drugs, compared with men (29.8%).
- Seniors living in low-income or rural/remote neighbourhoods were prescribed more drugs.
- Older seniors (age 85 and older) used a higher number of drugs.
- On average, the use of antipsychotics (used to treat schizophrenia and bipolar disorder) and benzodiazepines (used for anxiety and insomnia) in long-term care facilities has declined since 2011.
“While initiatives to decrease the use of potentially inappropriate drugs have been successful in reducing the use of antipsychotics and benzodiazepines, Canadian seniors are still taking a lot of drugs. It’s important for seniors and their families to have regular conversations with their physician or pharmacist about their medications.”
— Brent Diverty, Vice President, Programs, CIHI
"There is a growing awareness among prescribers, patients and the public about the harms of unnecessary medications. Canadian researchers, clinicians and prescribers are also doing something about it by developing evidence-based approaches to safely reduce unnecessary medications, and strategies specific to seniors to de-prescribe unnecessary and potentially harmful medications. This report will help drive change by providing more data and evidence to target priorities and support these strategies."
— Kimberly Wintemute, MD, CCFP, FCFP, Primary Care Co-Lead, Choosing Wisely Canada
The Canadian Institute for Health Information (CIHI) is an independent, not-for-profit organization that provides essential information on Canada’s health systems and the health of Canadians. Seniors are one of CIHI’s priority populations, as outlined in our strategic plan.
We provide comparable and actionable data and information that are used to accelerate improvements in health care, health system performance and population health across Canada. Our stakeholders use our broad range of health system databases, measurements and standards, together with our evidence-based reports and analyses, in their decision-making processes. We protect the privacy of Canadians by ensuring the confidentiality and integrity of the health care information we provide.