Impact of inappropriate drug use among hospitalized older adults

  • Graziano OnderEmail author
  • Francesco Landi
  • Rosa Liperoti
  • Daniela Fialova
  • Giovanni Gambassi
  • Roberto Bernabei
Pharmacoepidemiology and Prescription



Criteria for inappropriate drug use developed by Beers have been widely used in drug utilization reviews as the basis for educational materials and to assess the quality of prescribing. However, there is inconclusive evidence that these criteria can impact on patient outcomes. The objective of this study was to evaluate the impact of inappropriate drug use on all-cause mortality, adverse drug reactions (ADRs) and length of stay among in-hospital patients.


We performed a retrospective, cohort study on 5,152 patients aged 65 years or older admitted to 81 hospitals in Italy between 1997 and 1998. Inappropriate drug use was defined by 2003 Beers criteria. Outcomes of the study were: (a) in-hospital mortality; (b) incidence of ADR occurring during hospital stay; (c) length of hospital stay 13 days or more.


The mean age of 5,152 participants was 78.8 years (standard deviation = 8.4 years), and 2,463 (47.8%) were men. During hospital stay, 1,475 (28.6% of the study sample) patients received one or more inappropriate drugs. After adjusting for potential confounders, use of inappropriate drugs was not associated significantly with either mortality [odds ratio (OR) 1.05; 95% confidence intervals (CI): 0.75–1.48], ADR (OR 1.20; 95% CI: 0.89–1.61) or length of stay 13 days or more (OR 1.09; 95% CI: 0.95–1.25).


This study did not show any significant effect of inappropriate drug use defined by Beers 2003 criteria on health outcomes among hospitalized older adults. Further studies conducted in different settings, using additional health outcomes and alternate measures of inappropriate drug use, are needed.


Inappropriate drug use Older adults Mortality Adverse drug reactions In-hospital 



The GIFA study was partially supported by a grant from the National Research Council (n. 94000402) and by Neopharmed.


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Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Graziano Onder
    • 1
    Email author
  • Francesco Landi
    • 1
  • Rosa Liperoti
    • 1
  • Daniela Fialova
    • 2
  • Giovanni Gambassi
    • 1
    • 3
  • Roberto Bernabei
    • 1
  1. 1.Centro Medicina dell‘InvecchiamentoUniversità Cattolica del Sacro CuoreRomaItaly
  2. 2.Department Geriatrics, 1st Medical FacultyCharles University and Institute of Postgraduate Medical EducationPragueCzech Republic
  3. 3.Center for Gerontology and Health Care Research, Department of Community HealthBrown University Medical SchoolProvidenceUSA

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