Inappropriate medication prescribing in community-dwelling elderly people living in Iran

ObjectivesTo determine the prevalence of inappropriate medication prescribing in Middle Eastern community-dwelling elderly persons, and to determine factors associated with inappropriate prescribing.MethodsPrescriptions from 3,000 elderly-patient visits (≥65 years) to physicians in Isfahan, Iran were collected between September and December 2002; only the first patient visit was considered in the study. Inappropriate prescriptions were defined according to Beers’ explicit criteria (1997). The presence of at least one drug–drug interaction (DDI) and at least one drug-class duplication within each patient visit was also determined. Multivariate analyses were performed to determine factors associated with receiving at least one inappropriate medication. These factors included age, gender, number of prescribed medications per visit, DDIs, duplications, and physician’s number of years of experience. Similar analyses were performed to determine whether these factors were associated with a composite index (defined as having at least one of the following: receiving at least one inappropriate prescription, DDI, or duplication).ResultsThe mean age of our cohort was 72.6 (±5.7) years, and 1,735 (57.8%) were females. A total of 829 (27.6%) patients received at least one inappropriate prescription, 285 (9.5%) had at least one DDI during the visit, and 746 (24.9%) had at least one duplication during the visit. The three most inappropriately prescribed medication classes were antihistamines (29%), non-steroidal anti-inflammatory agents (23%) and benzodiazepines (16%). In multivariate analyses, the number of prescribed medications per visit was the only factor significantly associated with receiving at least one inappropriate prescription (OR 1.24; 95%CI: 1.16–1.32); analyses using the composite index as outcome gave similar results (OR: 1.70; 95%CI: 1.60–1.80).ConclusionOur findings indicate a high prevalence of inappropriate prescribing in elderly patients. Given the potential severity of this problem, further steps need to be implemented to prevent this occurrence.

[1]  G S Meyer,et al.  Potentially inappropriate medication use in the community-dwelling elderly: findings from the 1996 Medical Expenditure Panel Survey. , 2001, JAMA.

[2]  J. Avorn,et al.  Drug prescribing for the elderly. , 1986, Archives of internal medicine.

[3]  Lesley H Curtis,et al.  Inappropriate prescribing for elderly Americans in a large outpatient population. , 2004, Archives of internal medicine.

[4]  V. Mor,et al.  Inappropriate drug prescriptions for elderly residents of board and care facilities. , 1997, American journal of public health.

[5]  Morris Weinberger,et al.  Appropriateness of Medication Prescribing in Ambulatory Elderly Patients , 1994, Journal of the American Geriatrics Society.

[6]  U. Bergman,et al.  Quality of prescribing for the elderly in Croatia—computerized pharmacy data can be used to screen for potentially inappropriate prescribing , 2004, European Journal of Clinical Pharmacology.

[7]  D W Bates,et al.  Drugs and adverse drug reactions: how worried should we be? , 1998, JAMA.

[8]  John C. Beck,et al.  Explicit criteria for determining inappropriate medication use in nursing home residents. UCLA Division of Geriatric Medicine. , 1991 .

[9]  W A Ray,et al.  Possible Medication Errors in Home Healthcare Patients , 2001, Journal of the American Geriatrics Society.

[10]  J. Straand,et al.  Elderly patients in general practice: diagnoses, drugs and inappropriate prescriptions. A report from the Møre & Romsdal Prescription Study. , 1999, Family practice.

[11]  A. Akıcı,et al.  Drug utilization and potentially inappropriate drug use in elderly residents of a community in Istanbul, Turkey. , 2005, International journal of clinical pharmacology and therapeutics.

[12]  M. Llorente,et al.  Inappropriate Medication Prescribing in Homebound Older Adults , 1999, Journal of the American Geriatrics Society.

[13]  Y. Moride,et al.  Health Survey Data on Potentially Inappropriate Geriatric Drug Use , 2002, The Annals of pharmacotherapy.

[14]  H. Ulmer,et al.  Problematic drugs in elderly patients presenting to a European emergency room. , 2003, European journal of internal medicine.

[15]  D. Himmelstein,et al.  Inappropriate drug prescribing for the community-dwelling elderly. , 1994, JAMA.

[16]  M. Beers,et al.  Explicit criteria for determining potentially inappropriate medication use by the elderly. An update. , 1997, Archives of internal medicine.

[17]  J. Tornatore,et al.  Potentially Inappropriate Medication Use in Community Residential Care Facilities , 2003, The Annals of pharmacotherapy.

[18]  P. Friedmann,et al.  Appropriateness of medication selection for older persons in an urban academic emergency department. , 1999, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[19]  T. Strandberg,et al.  Inappropriate drug prescribing in home-dwelling, elderly patients: a population-based survey. , 2002, Archives of internal medicine.

[20]  Mark E. Williams,et al.  Reliability of a Modified Medication Appropriateness Index in Ambulatory Older Persons , 1997, The Annals of pharmacotherapy.

[21]  J. Dartigues,et al.  Frequency and risk factors of potentially inappropriate medication use in a community-dwelling elderly population: results from the 3C Study , 2004, European Journal of Clinical Pharmacology.

[22]  G P Samsa,et al.  A summated score for the medication appropriateness index: development and assessment of clinimetric properties including content validity. , 1994, Journal of clinical epidemiology.

[23]  C. Pedersen,et al.  Potential Adverse Drug Events in an Indigent and Homeless Geriatric Population , 2001, The Annals of pharmacotherapy.

[24]  M. Cesari,et al.  PHARMACOEPIDEMIOLOGY AND PRESCRIPTION Inappropriate medication use among hospitalized older adults in Italy : results from the Italian Group of Pharmacoepidemiology in the Elderly , 2003 .

[25]  R. Aparasu,et al.  Inappropriate prescribing for elderly outpatients. , 1999, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[26]  R. Aparasu,et al.  Inappropriate Medication Prescribing for the Elderly by Office-Based Physicians , 1997, The Annals of pharmacotherapy.

[27]  L. Rubenstein,et al.  Inappropriate medication use in community-residing older persons. , 1994, Archives of internal medicine.

[28]  A. Wimo,et al.  The Association of Inappropriate Drug Use with Hospitalisation and Mortality , 2005, Drugs & Aging.

[29]  H. Rappaport,et al.  Inappropriate drug prescribing and related outcomes for elderly medicaid beneficiaries residing in nursing homes. , 1996, Clinical therapeutics.