Psychoactive medication use among older community-dwelling Americans



      Falls are a common and serious health issue among older Americans. A common fall risk factor is the use of psychoactive medications. There is limited recent information on the national prevalence of psychoactive medication use among older Americans.


      To estimate the prevalence of psychoactive medication use among community-dwelling older Americans and compare it with previous estimates from 1996.


      The data source was the 2013 Cost and Use Data files combining Medicare claims data and survey data from the Medicare Current Beneficiary Survey, an in-person nationally representative survey of Medicare beneficiaries. Participants were included if they were 65 years of age and older, lived in the community, and had a complete year of prescription use data. Medication use was examined for 7 classes of psychoactive medications categorized by the 2015 American Geriatric Society Beers criteria as increasing fall risk. These include opioids, benzodiazepines, selective serotonin reuptake inhibitors, anticonvulsants, nonbenzodiazepine sedative hypnotics, antipsychotics, and tricyclic antidepressants. Data on participant demographic factors were also collected.


      Among the 6959 community-dwelling older adults studied, representing 33,268,104 community-dwelling Medicare beneficiaries, 53.3% used at least 1 psychoactive medication linked to falls in 2013. The most frequently used medication classes were opioids (34.9%), benzodiazepines (15.4%), selective serotonin reuptake inhibitors (14.3%), and anticonvulsants (13.3%). These estimates are considerably higher for all classes except tricyclic antidepressants than previous reports from 1996 that used the same data source. Among most psychoactive medication classes observed, women had higher usage than men.


      More than half of all older Americans used at least 1 psychoactive medication in 2013. Health care providers, including pharmacists, play a vital role in managing older adults’ exposure to psychoactive medications. Medication management can optimize health and reduce older adult falls.
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        • Centers for Disease Control and Prevention
        Web-based Injury Statistics Query and Reporting System (WISQARS).
        (Available at: December 1, 2017
        • Bergen G.
        • Stevens M.R.
        • Burns E.R.
        Falls and fall injuries among adults aged ≥65 years—United States, 2014.
        MMWR Morb Mortal Wkly Rep. 2016; 65: 993-998
        • Sterling D.A.
        • O’Connor J.A.
        • Bonadies J.
        Geriatric falls: injury severity is high and disproportionate to mechanism.
        J Trauma. 2001; 50: 116-119
        • Florence C.S.
        • Bergen G.
        • Atherly A.
        • Burns E.
        • Stevens J.
        • Drake C.
        Medical costs of fatal and nonfatal falls in older adults.
        J Am Geriatr Soc. 2018; 66: 693-698
        • Ambrose A.F.
        • Paul G.
        • Hausdorff J.M.
        Risk factors for falls among older adults: a review of the literature.
        Maturitas. 2013; 75: 51-61
        • Gillespie L.D.
        • Robertson M.C.
        • Gillespie W.J.
        • et al.
        Interventions for preventing falls in older people living in the community.
        Cochrane Database Syst Rev. 2012; : CD007146
        • Hartikainen S.
        • Lonnroos E.
        • Louhivuori K.
        Medication as a risk factor for falls: critical systematic review.
        J Gerontol A Biol Sci Med Sci. 2007; 62: 1172-1181
        • Woolcott J.C.
        • Richardson K.J.
        • Wiens M.O.
        • et al.
        Meta-analysis of the impact of 9 medication classes on falls in elderly persons.
        Arch Intern Med. 2009; 169: 1952-1960
        • Leipzig R.M.
        • Cumming R.G.
        • Tinetti M.E.
        Drugs and falls in older people: a systematic review and meta-analysis: I. Psychotropic drugs.
        J Am Geriatr Soc. 1999; 47: 30-39
        • American Geriatrics Society 2015 Beers Criteria Update Expert Panel
        American Geriatrics Society 2015 updated Beers criteria for potentially inappropriate medication use in older adults.
        J Am Geriatr Soc. 2015; 63: 2227-2246
        • Gerlach L.B.
        • Olfson M.
        • Kales H.C.
        • Maust D.T.
        Opioids and other central nervous system–active polypharmacy in older adults in the United States.
        J Am Geriatr Soc. 2017; 65: 2052-2056
        • Salahudeen M.S.
        • Duffull S.B.
        • Nishtala P.S.
        Anticholinergic burden quantified by anticholinergic risk scales and adverse outcomes in older people: a systematic review.
        BMC Geriatrics. 2015; 15: 31
        • Tune L.E.
        Anticholinergic effects of medication in elderly patients.
        J Clin Psychiatry. 2001; 62: 11-14
        • Campbell A.J.
        • Robertson M.C.
        • Gardner M.M.
        • Norton R.N.
        • Buchner D.M.
        Psychotropic medication withdrawal and a home-based exercise program to prevent falls: a randomized, controlled trial.
        J Am Geriatr Soc. 1999; 47: 850-853
        • Moxey E.D.
        • O’Connor J.P.
        • Novielli K.D.
        • Teutsch S.
        • Nash D.D.
        Prescription drug use in the elderly: a descriptive analysis.
        Health Care Financ Rev. 2003; 24: 127-141
        • Lichtenberg F.
        • Sun S.
        The impact of Medicare Part D on prescription drug use by the elderly.
        Health Aff (Millwood). 2007; 26: 1735-1744
        • Moeller J.F.
        • Miller G.E.
        • Banthin J.S.
        Looking inside the nation’s medicine cabinet: trends in outpatient drug spending by Medicare beneficiaries, 1997 and 2001.
        Health Aff (Millwood). 2004; 23: 217-225
        • Levy B.
        • Paulozzi L.
        • Mack K.A.
        • Jones C.M.
        Trends in opioid analgesic–prescribing rates by specialty, U.S., 2007–2012.
        Am J Prev Med. 2015; 49: 409-413
        • Musich S.
        • Wang S.S.
        • Ruiz J.
        • Hawkins K.
        • Wicker E.
        Falls-related drug use and risk of falls among older adults: a study in a US Medicare population.
        Drugs Aging. 2017; 34: 555-565
        • Centers for Medicare and Medicaid Services
        Medicare Current Beneficiary Survey: CY 2013 cost and use files.
        2015 (Available at: Accessed June 5, 2019.)
        • van der Cammen T.J.
        • Rajkumar C.
        • Onder G.
        • Sterke C.S.
        • Petrovic M.
        Drug cessation in complex older adults: time for action.
        Age Ageing. 2014; 43: 20-25
        • Thompson W.
        • Farrell B.
        Deprescribing: what is it and what does the evidence tell us?.
        Can J Hosp Pharm. 2013; 66: 201-202
        • Panel on Prevention of Falls in Older Adults, American Geriatrics Society and British Geriatrics Society
        Summary of the Updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons.
        J Am Geriatr Soc. 2011; 59: 148-157
        • Karani M.V.
        • Haddad Y.
        • Lee R.
        The role of pharmacists in preventing falls among America’s older adults.
        Front Pub Health. 2016; 4: 250
        • Reeve E.
        • Low L.F.
        • Hilmer S.N.
        Beliefs and attitudes of older adults and carers about deprescribing of medications: a qualitative focus group study.
        Br J Gen Pract. 2016; 66: e552-e560
        • Reeve E.
        • Wiese M.D.
        • Hendrix I.
        • Roberts M.S.
        • Shakib S.
        People’s attitudes, beliefs, and experiences regarding polypharmacy and willingness to deprescribe.
        J Am Geriatr Soc. 2013; 61: 1508-1514
        • Sirois C.
        • Ouellet N.
        • Reeve E.
        Community-dwelling older people’s attitudes towards deprescribing in Canada.
        Res Social Admin Pharm. 2017; 13: 864-870
        • Tannenbaum C.
        • Martin P.
        • Tamblyn R.
        • Benedetti A.
        • Ahmed S.
        Reduction of inappropriate benzodiazepine prescriptions among older adults through direct patient education: the EMPOWER cluster randomized trial.
        JAMA Intern Med. 2014; 174: 890-898
        • Rubio-Valera M.
        • Chen T.
        • Reilly C.
        New roles for pharmacists in community mental health care: a narrative review.
        Int J Environ Res Public Health. 2014; 11: 10967-10990
        • Dalleur O.
        • Boland B.
        • Losseau C.
        • et al.
        Reduction of potentially inappropriate medications using the STOPP criteria in frail older inpatients: a randomised controlled study.
        Drugs Aging. 2014; 31: 291-298
        • Hilmer S.N.
        • Mager D.E.
        • Simonsick E.M.
        • et al.
        A drug burden index to define the functional burden of medications in older people.
        Arch Intern Med. 2007; 167: 781-787
        • Naples J.G.
        • Marcum Z.A.
        • Perera S.
        • et al.
        Concordance between anticholinergic burden scales.
        J Am Geriatr Soc. 2015; 63: 2120-2124


      Yara K. Haddad, PharmD, MPH, BCGP, Pharmacist Consultant, Totally Joined for Achieving Collaborative Techniques, Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA


      Feijun Luo, PhD, Economist. Division of Research and Practice Integration, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA


      Mamta V. Karani, PharmD, BCPS, Research Fellow, Oak Ridge Associated Universities, Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA


      Zachary A. Marcum, PharmD, PhD, BCPS, Assistant Professor, Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, WA


      Robin Lee, PhD, MPH, Home and Recreation Team Lead, Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA