Potentially inappropriate medications in the elderly: a French consensus panel list
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To evaluate drug-related problems in the elderly, various lists of potentially inappropriate medications have been published in North America. Unfortunately, these lists are hardly applicable in France. The purpose of this study was to establish a list of inappropriate medications for French elderly using the Delphi method.
A two-round Delphi method was used to converge to an agreement between a pool of 15 experts from various parts of France and from different backgrounds (five geriatricians, five pharmacologists, two pharmacists, two general practitioners, one pharmacoepidemiologist). In round one, they were sent a questionnaire based on a literature review listing medications and clinical situations. They were asked to comment on the potential inappropriateness of the criteria proposed using a 5-point Likert scale (from strong agreement to strong disagreement) and to suggest therapeutic alternatives and new criteria. In round two, the experts confirmed or cancelled their previous answers from the synthesis of the responses of round one. After round two, a final list of potentially inappropriate drugs was established.
The final list proposed 36 criteria applicable to people ≥75 years of age. Twenty-nine medications or medication classes applied to all patients, and five criteria involved medications that should be avoided in specific medical conditions. Twenty-five medications or medication classes were considered with an unfavourable benefit/risk ratio, one with a questionable efficacy and eight with both unfavourable benefit/risk ratio and questionable efficacy.
This expert consensus should provide prescribers with an epidemiological tool, a guideline and a list of alternative therapies.
KeywordsInappropriate medications Elderly Delphi method France
nonsteroidal antiinflammatory drug
serotonin and noradrenaline reuptake inhibitor
selective serotonin reuptake inhibitor
We acknowledge the following individuals for contributing their expertise to this study as panel members: Martine Alt, Jean-Pierre Charmes, Claire Dessoudeix, Jean Doucet, Annie Fourrier, Philippe Gaertner, Marie-Claude Guelfi, Alain Jean, Marie-Josèphe Jean-Pastor, Claude Jeandel, Jean-Pierre Kantelip, Louis Merle, Jean-Louis Montastruc, François Piette, Jean-Marie Vetel.
- 4.McLeod PJ, Huang AR, Tamblyn RM, Gayton DC (1997) Defining inappropriate practices in prescribing for elderly people: a national consensus panel. Can Med Assoc J 156:385–391Google Scholar
- 5.Fialova D, Topinkova E, Gambassi G, Finne-Soveri H, Jonsson PV, Carpenter I, Schroll M, Onder G, Sorbye LW, Wagner C, Reissigova J, Bernabei R, AdHOC Project Research Group (2005) Potentially inappropriate medication use among elderly home care patients in Europe. JAMA 293:1348–1358PubMedCrossRefGoogle Scholar
- 7.Lechevallier-Michel N, Gautier-Bertrand M, Alperovitch A, Berr C, Belmin J, Legrain S, Saint-Jean O, Tavernier B, Dartigues JF, Fourrier-Reglat A, The 3C Study Group (2005) Frequency and risk factors of potentially inappropriate medication use in a community-dwelling elderly population: results from the 3C study. Eur J Clin Pharmacol 60:813–819PubMedCrossRefGoogle Scholar
- 10.Dalkey NC (1969) The Delphi method: an experimental study of a group opinion. Rand Corporation, Santa MonicaGoogle Scholar
- 17.Stevens B, McGrath P, Yamada J, Gibbins S, Beyene J, Breau L, Camfield C, Finley A, Franck L, Howlett A, Johnston C, McKeever P, O’Brien K, Ohlsson A (2006) Identification of pain indicators for infants at risk for neurological impairment: A Delphi consensus study. BMC Pediatrics 6:1PubMedCrossRefGoogle Scholar