Inappropriate Drug Use by Portuguese Elderly Outpatients--effect of the Beers Criteria Update

Overview

Journal Pharm World Sci

Publisher Springer

Specialties Pharmacology
Pharmacy

Date 2006 Nov 18

PMID 17111245

Citations 26

Authors

Sofia de Oliveira Martins

Maria Augusta Soares

J W Foppe van Mil

Jose Cabrita

Affiliations

Soon will be listed here.

Abstract

Objective: To characterize the use of medicines and to evaluate the inappropriateness of drugs in elderly outpatient population.

Setting: Twelve community pharmacies in different districts of Lisbon-Portugal.

Method: Observational cross-sectional survey, in a sample of 213 elderly outpatients (age>or=65-years-old) presenting a prescription with two or more drugs, for their own use.

Main Outcome Measures: Drug use pattern and prevalence of potentially inappropriate medication.

Results: We have studied 213 outpatients, who were taking a total of 1,543 drugs, with an average of 7.23 per patient. The drugs were distributed mainly in the following 3 ATC (Anatomical Therapeutic Chemical Classification) classes: C (cardiovascular system), N (nervous system) and A (alimentary tract). Using the 1997 Beers Explicit criteria, 75 occurrences of inappropriate medicines were detected in 59 patients (27.7%), while with the 2003 Beers Explicit criteria we detected 114 cases of inappropriate medication in 82 patients (38.5%). The occurrence of inappropriate medicines was significantly associated with the consumption of a high number of drugs. According to the ATC Classification, more than one half of the cases of inappropriateness were related with long acting benzodiazepines and with ticlopidine. The 2003 version detected a significantly higher prevalence of inappropriate drug use having potentially adverse outcomes of high severity.

Conclusions: The application of the updated Beers criteria lead to higher rates of potentially inappropriate medication, and especially those responsible for more severe adverse outcomes. The results suggest that there is a need for interventions to improve instructions for safe drug use in the elderly patients and to decrease the number of medications whenever it is possible. This study suggests a high prevalence of potentially inappropriate drug use by the elderly patients of Lisbon region, Portugal.

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References

Hanlon J, Schmader K, Boult C, Artz M, Gross C, Fillenbaum G . Use of inappropriate prescription drugs by older people. J Am Geriatr Soc. 2002; 50(1):26-34. DOI: 10.1046/j.1532-5415.2002.50004.x. View

Huang B, Bachmann K, He X, Chen R, McAllister J, Wang T . Inappropriate prescriptions for the aging population of the United States: an analysis of the National Ambulatory Medical Care Survey, 1997. Pharmacoepidemiol Drug Saf. 2002; 11(2):127-34. DOI: 10.1002/pds.688. View

Laurier C, Moride Y, Kennedy W . Health survey data on potentially inappropriate geriatric drug use. Ann Pharmacother. 2002; 36(3):404-9. DOI: 10.1345/aph.1Z445. View

Beers M, Ouslander J, Rollingher I, Reuben D, Brooks J, Beck J . Explicit criteria for determining inappropriate medication use in nursing home residents. UCLA Division of Geriatric Medicine. Arch Intern Med. 1991; 151(9):1825-32. View

Piecoro L, Browning S, Prince T, Ranz T, Scutchfield F . A database analysis of potentially inappropriate drug use in an elderly medicaid population. Pharmacotherapy. 2000; 20(2):221-8. DOI: 10.1592/phco.20.3.221.34779. View

Fick D, Cooper J, Wade W, Waller J, Maclean J, Beers M . Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med. 2003; 163(22):2716-24. DOI: 10.1001/archinte.163.22.2716. View

Mannesse C, Derkx F, de Ridder M, Man in t Veld A, van der Cammen T . Contribution of adverse drug reactions to hospital admission of older patients. Age Ageing. 2000; 29(1):35-9. DOI: 10.1093/ageing/29.1.35. View

Fu A, Liu G, Christensen D . Inappropriate medication use and health outcomes in the elderly. J Am Geriatr Soc. 2004; 52(11):1934-9. DOI: 10.1111/j.1532-5415.2004.52522.x. View

Kirby M, Denihan A, Bruce I, Radic A, Coakley D, Lawlor B . Benzodiazepine use among the elderly in the community. Int J Geriatr Psychiatry. 1999; 14(4):280-4. View

10.

Rancourt C, Moisan J, Baillargeon L, Verreault R, Laurin D, Gregoire J . Potentially inappropriate prescriptions for older patients in long-term care. BMC Geriatr. 2004; 4:9. PMC: 529256. DOI: 10.1186/1471-2318-4-9. View

11.

Monane M, Matthias D, Nagle B, Kelly M . Improving prescribing patterns for the elderly through an online drug utilization review intervention: a system linking the physician, pharmacist, and computer. JAMA. 1998; 280(14):1249-52. DOI: 10.1001/jama.280.14.1249. View

12.

Bartlett G, Abrahamowicz M, Tamblyn R, Grad R, capek R, Du Berger R . Longitudinal patterns of new Benzodiazepine use in the elderly. Pharmacoepidemiol Drug Saf. 2004; 13(10):669-82. DOI: 10.1002/pds.908. View

13.

Schmader K, Hanlon J, Weinberger M, Landsman P, Samsa G, Lewis I . Appropriateness of medication prescribing in ambulatory elderly patients. J Am Geriatr Soc. 1994; 42(12):1241-7. DOI: 10.1111/j.1532-5415.1994.tb06504.x. View

14.

Beers M . Explicit criteria for determining potentially inappropriate medication use by the elderly. An update. Arch Intern Med. 1997; 157(14):1531-6. View

15.

Stuart B, Kamal-Bahl S, Briesacher B, Lee E, Doshi J, Zuckerman I . Trends in the prescription of inappropriate drugs for the elderly between 1995 and 1999. Am J Geriatr Pharmacother. 2004; 1(2):61-74. DOI: 10.1016/s1543-5946(03)90002-x. View

16.

Spiker E, Emptage R, Giannamore M, Pedersen C . Potential adverse drug events in an indigent and homeless geriatric population. Ann Pharmacother. 2001; 35(10):1166-72. DOI: 10.1345/aph.10411. View

17.

Hanlon J, Schmader K, Koronkowski M, Weinberger M, Landsman P, Samsa G . Adverse drug events in high risk older outpatients. J Am Geriatr Soc. 1997; 45(8):945-8. DOI: 10.1111/j.1532-5415.1997.tb02964.x. View

18.

Mort J, Aparasu R . Prescribing potentially inappropriate psychotropic medications to the ambulatory elderly. Arch Intern Med. 2000; 160(18):2825-31. DOI: 10.1001/archinte.160.18.2825. View

19.

Heininger-Rothbucher D, Daxecker M, Ulmer H, Gritsch W, Pechlaner C, Wiedermann C . Problematic drugs in elderly patients presenting to a European emergency room. Eur J Intern Med. 2004; 14(6):372-376. DOI: 10.1016/s0953-6205(03)90004-5. View

20.

Mott D, Meek P . Evaluating prescriptions for the elderly: drug/age criteria as a tool to help community pharmacists. J Am Pharm Assoc (Wash). 2000; 40(3):417-24. DOI: 10.1016/s1086-5802(16)31090-7. View