The 1991 release of the Beers list — an index of potentially dangerous drugs for seniors — prompted many patients to search their medicine chests and double-check their prescription pill bottles for possible health hazards.

A panel of experts in the fields of geriatric care, clinical pharmacology and psychopharmacology compiled the Beers List, identifying medications that may pose a serious health risk to seniors. (Mel Evans/Associated Press)

The list, compiled by a U.S. team of 12 health experts led by Dr. Mark Beers, was initially created to determine which drugs should be used in ambulatory and nursing homes, given that seniors were particularly at risk from suffering adverse side-effects, including falls, depression and, in extreme cases, death.

Critics initially deemed the list controversial, saying it was shaped by opinion over scientific data. They also claimed the list might prevent some seniors from receiving effective treatment, saying that every patient ages and reacts differently to drug treatments.

Still, the Beers list, which was updated in 2003, has proved to have far-reaching applications, used by health-care professionals and researchers studying a range of subjects including prescribing patterns and medication use in seniors.

Fewer seniors taking Beers list drugs: CIHI report

In September 2007, the Canadian Institute for Health Information (CIHI) noted fewer seniors have suffered adverse side-effects linked to prescription medicine since 2000. Using prescribed drug claims in Alberta, Manitoba, Saskatchewan and New Brunswick, CIHI found that 27 per cent of seniors took Beers list drugs in 2005-06, down from 34 per cent in 2000-01.

Beers said the CIHI results were positive, but also indicate that more educational work is necessary.

"I'm encouraged on a number of fronts, there's been a large reduction in the use of these medications," Beers said.

What is an adverse reaction?

Adverse side-effects are unexpected reactions to medications. Side-effects ranging from rashes to liver damage are not typically listed in the product's accompanying literature. The reactions may happen when a patient is using the product as directed and can occur within minutes or years.

"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."

The issue of over-prescribing has been a contentious issue in Canada. In 2005, a CBC investigation found that as many as 3,300 seniors were dying annually from adverse drug reactions across the country. Seniors, who make up 13 per cent of the population, accounted for 44.4 per cent of all deaths reported to Health Canada's adverse drug reaction database between 1999 and 2003.

Health Canada noted that drug use among seniors was notably higher compared with the rest of the population, with people over 65 accounting for 40 per cent of all medications. But health experts said the statistics were reflective of a larger prescribing culture, in which doctors were too quick to send patients home with pills to cure their ailments.

Antidepressant, hormone replacement treatments still commonly used

While the results from the 2007 CIHI study reflect greater awareness, the study notes there has been an upsurge in use of certain higher-risk drugs included on the Beers list, including the antidepressant amitriptyline. In particular, five drugs claimed by chronic users are still being widely used, despite advice that suggests they are higher-risk treatments.

Top 5 Beers list drugs most prescribed and claimed by chronic users: CIHI

Drug	Condition	Reason for inclusion on Beers list
Oral conjugated estrogens	Hormone replacement	Evidence of the carcinogenic (breast and endometrial cancer) potential of these agents and lack of cardioprotective effect in older women.
Amitriptyline	Antidepressant	Because of its strong anticholinergic and sedation properties, amitriptyline is rarely the antidepressant of choice for elderly patients. May produce ataxia, impaired psychomotor function, syncope and additional falls.
Digoxin	Heart conditions	Decreased renal clearance may lead to increased risk of toxic effects.
Oxybutynin	Incontinence	Most muscle relaxants and antispasmodic drugs are poorly tolerated by elderly patients, since these cause anticholinergic adverse effects, sedation and weakness. Additionally, their effectiveness at doses tolerated by elderly patients is questionable.
Temazepam	Sleep disorders	Because of increased sensitivity to benzodiazepines in elderly patients, smaller doses may be effective as well as safer.

The study also found that 17.3 per cent of women were chronic users of Beers drugs, as compared with 11 per cent of men. In both men and women, people over the age of 85 were the highest chronic users of drugs included in the Beers list.

Demand answers to your questions, Beers says

A September 2007 CIHI report has found a notable decrease in adverse drug reactions among seniors since the Beers report was first issued in 1991. (Nati Harnik/Associated Press)

Since the list was first released in 1991, drug companies have improved the formulary of medications for seniors, Beers said, but consumers must also be their own advocate and question doctors about medications.

"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?'" he said, noting that when doctors are questioned it spurs them to do more research.

"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," he said.