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VA RESEARCH FINDS IMPROPER ANTIHISTAMINE USE
COMMON IN OLDER ADULTS -- Antihistamines are
known to
increase the risk of falls and confusion among
older patients.
Story here...
http://www.medpagetoday.com/
MeetingCoverage/AGS/tb/5597
Story below:
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Improper Antihistamine Use Common in Older Adults
By Crystal Phend, Staff Writer, MedPage Today
Reviewed by Zalman S. Agus, MD; Emeritus Professor at
the University of Pennsylvania School of Medicine.
SEATTLE -- Only 16% of sedating antihistamine use among older patients
at VA medical centers was for an appropriate indication, researchers
reported here.
Action Points
* Explain to interested patients that sedating antihistamines used
inappropriately for older patients may carry risk of falls and
confusion.
* This study was published as an abstract and presented orally at a
conference. These data and conclusions should be considered to be
preliminary until published in a peer-reviewed publication.
An "alarmingly high" 44% of the potentially inappropriate antihistamine
uses were as sleep aids, noted Monica Horton, M.D., of the South Texas
Veterans Healthcare System and the University of Texas Health Science
Center at San Antonio, and colleagues.
Antihistamines are known to increase the risk of falls and confusion
among older patients, who are "more susceptible to adverse events of
drugs with anticholinergic properties," Dr. Horton said at the American
Geriatrics Society meeting.
"It's over-the-counter, it's cheap, it works," she said, "But I think
[these physicians] are not considering the risk of falls and confusion."
In their study, the researchers further analyzed a database established
by a prior study of potentially inappropriate prescribing in veterans
age 65 and older. The prior study used ICD-9 codes from the National VA
inpatient, outpatient, and pharmacy databases for 1999.
Inappropriate use was defined by the so-called Zhan criteria -- the
conclusions of an Agency for Healthcare Research and Quality consensus
panel -- stating that allergy and urticaria should be the only
indications for antihistamines in older adults.
The researchers classified each prescribed use as being "definite or
probable" for insomnia, for allergy and rash, for psychiatric use, or
for an unclear or unusual indication but unlikely to be for sleep.
Their findings:
* 16% of the 150,000 coded antihistamine directions for use were clearly
for an appropriate indication.
* 44% of inappropriate uses were "definite or probable" for sleep
indications.
* 37% of inappropriate uses were for vague indications, but unlikely to
be for sleep.
* 2% of inappropriate uses were for psychiatric indications.
* 0.5% of inappropriate uses were for missing indications.
Rather than antihistamines, physicians should pursue other safer and
less risky therapies for insomnia, Dr. Horton said. She advocated
nonpharmacologic measures but said trazodone (Desyrel) could be an
inexpensive alternative as well.
Further research is needed to determine if the potentially inappropriate
antihistamine use they discovered has resulted in worse outcomes for
patients, she said.
"A fall is a significant event," Dr. Horton said. "The elderly folks
could lose their independence and go to a nursing home because of a
fall."
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Larry Scott --
