Inappropriate medication use among hospitalized older adults in Italy: results from the Italian Group of Pharmacoepidemiology in the Elderly
- 362 Downloads
To determine the prevalence of inappropriate medication use among hospitalized older adults and to identify predictors of this use.
A total of 5734 patients (mean age 79 years) admitted to geriatric and internal medicine wards participating in the study in 1995 and 1997 were included in this analysis. Inappropriate medication use was defined on the basis of the criteria published by Beers in 1997. Only medications used during hospital stay were considered for the present study.
During hospital stay, 837 (14.6%) patients received one or more medications classified as inappropriate based on Beers criteria. Ticlopidine (n=346; 6.0% of the study sample) was the most frequently used medication among those in Beers' list, followed by digoxin (n=174; 3.0%) and amytriptyline (n=113; 2.0%). The multivariate analysis showed that age [75–84 years vs 65–74 years, odds ratio (OR) 0.85, 95% confidence interval (CI) 0.71–1.00; ≥85 years vs 65–74 years, OR 0.58, 95% CI 0.46–0.73], cognitive impairment (OR 0.77, 95% CI 0.64–0.94), Charlson co-morbidity index (≥2 vs 0–1, OR 1.20, 95% CI 1.02–1.40) and overall number of medications used during hospital stay (5–8 medications vs <5 medications, OR 2.20, 95% CI 1.72–2.82; ≥9 medications vs <5 medications, OR 3.68, 95% CI 2.86–4.73) were significantly associated with use of inappropriate medications.
Inappropriate medication use was common among hospitalized older adults. The most important determinant of risk of receiving an inappropriate medication was the number of drugs being taken. Older age and cognitive impairment were associated with a reduced likelihood of using an inappropriate medication.
KeywordsElderly Inappropriate medication use In-hospital patients
The GIFA study was partially supported by a grant from the National Research Council (no. 94000402) and by Neopharmed.
- 1.Einarson TR (1993) Drug-related hospital admissions. Ann Pharmacother 27:832–840Google Scholar
- 4.Carbonin P, Pahor M, Bernabei R, Sgadari A (1991) Is age an independent risk factor of adverse drug reactions in hospitalized medical patients? J Am Geriatr Soc 39:1093–1099Google Scholar
- 7.Bates DW (1998) Drugs and adverse drug reactions: how worried should we be? JAMA 279:1216–1217Google Scholar
- 9.Stuck AE, Beers MH, Steiner A, Aronow HU, Rubenstein LZ, Beck JC (1994) Inappropriate medication use in community-residing older persons. Arch Intern Med 154:2195–2200Google Scholar
- 10.Beers MH (1997) Explicit criteria for determining potentially inappropriate medication use by the elderly. An update. Arch Intern Med 157:1531–1536Google Scholar
- 27.PHS-HCFA (1980) International classification of diseases, 9th rev. Public Health Service-Health Care Financing Administration, WashingtonGoogle Scholar
- 28.Charlson ME, Pompei P, Ales KL, Mackenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis 40:373–383Google Scholar
- 31.Cerbone AM, Tufano A, Di Minno G (2000) Linee Guida di terapia antitrombotica nel paziente anziano. Giorn Geront 48:419–433Google Scholar
- 35.Onder G, Gambassi G, Landi F, Pedone C, Cesari M, Carbonin PU, Bernabei R (2001) Trends in antihypertensive drugs in the elderly: the decline of thiazides. J Hum Hypertens 15:291–297Google Scholar
- 36.Berlowitz DR, Ash AS, Hickey EC, Friedman RH, Glickman M, Kader B, Moskowitz MA (1998) Inadequate management of blood pressure in a hypertensive population. N Engl J Med 339:1957–1963Google Scholar