CNS Polypharmacy in Seniors Doubled From 2004 to 2013, Study Finds

Between 2004 and 2013, the number of Americans 65 and older who took three or more central nervous system (CNS) medications doubled, according to a study published today in JAMA Internal Medicine. In nearly half of these cases, the seniors—who were taking antidepressants, antipsychotics, painkillers, and/or sleep aids—did not appear to have a mental health or pain diagnosis.

The findings suggest that despite concerns over the risks of CNS polypharmacy, some older patients continue to be prescribed multiple CNS medications at once.

Donovan Maust, M.D., a geriatric psychiatrist at the University of Michigan Medical School in Ann Arbor, and colleagues analyzed data on patients 65 or older from the 2004 through 2013 National Ambulatory Medical Care Survey (NAMCS), which included 97,910 patients.

They found that annual polypharmacy visits by seniors rose from 0.6% in 2004 to 1.4% in 2013. Applied to the entire U.S. senior population, this translates to an increase from 1.5 million annual doctor visits to 3.68 million annual doctor visits involving CNS polypharmacy. The sharpest rise in CNS polypharmacy occurred among seniors living in rural areas, where mental health specialists are rare. The rate of rural polypharmacy visits tripled during the study period, and rural patients accounted for 16.6% of all CNS polypharmacy visits in 2013.

“Because of limited access to specialty care and a preference to receive treatment in primary care settings, it is unsurprising that mental health treatment has expanded in nonpsychiatric settings,” the researchers wrote. “The growth in polypharmacy in rural settings, where access to specialty mental health or pain care is particularly limited, is part of this broader trend.”

For related information, see the Psychiatric Services study “Antidepressant Prescribing in Primary Care to Older Adults Without Major Depression,” also by Donovan Maust, M.D., and colleagues.

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