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European Journal of Clinical Pharmacology

, Volume 63, Issue 8, pp 725–731 | Cite as

Potentially inappropriate medications in the elderly: a French consensus panel list

  • Marie-Laure Laroche
  • Jean-Pierre Charmes
  • Louis MerleEmail author
Special Article

Abstract

Objective

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.

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.

Results

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.

Conclusion

This expert consensus should provide prescribers with an epidemiological tool, a guideline and a list of alternative therapies.

Keywords

Inappropriate medications Elderly Delphi method France 

Abbreviations

NSAID

nonsteroidal antiinflammatory drug

SNRI

serotonin and noradrenaline reuptake inhibitor

SSRI

selective serotonin reuptake inhibitor

IMs

inappropriate medications

Notes

Acknowledgements

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.

References

  1. 1.
    Beers MH, Ouslander JG, Rollinger I, Brooks J, Reuben D, Beck JC (1991) Explicit criteria for determining IM use in nursing homes. Arch Intern Med 151:1825–1832PubMedCrossRefGoogle Scholar
  2. 2.
    Beers MH (1997) Explicit criteria for determining potentially IM use by the elderly. An update. Arch Intern Med 157:1531–1536PubMedCrossRefGoogle Scholar
  3. 3.
    Fick DM, Cooper JW, Wade WE, Waller JL, Maclean JR, Beers MH (2003) Updating the Beers criteria for potentially IM use in older adults. Results of a US consensus panel of experts. Arch Intern Med 163:2716–2724PubMedCrossRefGoogle Scholar
  4. 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. 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
  6. 6.
    Gallagher P, Barry P, O’Mahony D (2007) Inappropriate prescribing in the elderly. J Clin Pharm Ther 32: 113–121PubMedCrossRefGoogle Scholar
  7. 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
  8. 8.
    Laroche ML, Charmes JP, Nouaille Y, Fourrier A, Merle L (2006) Impact of hospitalisation on inappropriate medication use in the elderly. Drugs Aging 23:49–59PubMedCrossRefGoogle Scholar
  9. 9.
    Laroche ML, Charmes JP, Nouaille Y, Picard N, Merle L (2007) Is inappropriate medication use a major cause of adverse drug reactions in the elderly? Br J Clin Pharmacol 63:177–186PubMedCrossRefGoogle Scholar
  10. 10.
    Dalkey NC (1969) The Delphi method: an experimental study of a group opinion. Rand Corporation, Santa MonicaGoogle Scholar
  11. 11.
  12. 12.
    Matell MS, Jacoby J (1971) Is there an optimal number of alternatives for Likert scale items? I: reliability and validity. Educ Psychol Measure 31:657–674CrossRefGoogle Scholar
  13. 13.
    Merle L, Laroche ML, Dantoine T, Charmes JP (2005) Predicting and preventing adverse drug reactions in the very old. Drugs Aging 22:375–392PubMedCrossRefGoogle Scholar
  14. 14.
    Lafuente-Lafuente C, Mouly S, Longas-Tejero MA, Mahe I, Bergmann JF (2006) Antiarrhythmic drugs for maintaining sinus rhythm after cardioversion of atrial fibrillation : a systematic review of randomized controlled trials. Arch Intern Med 166:719–728PubMedCrossRefGoogle Scholar
  15. 15.
    Caplin DA, Rao JK, Filloux F, Bale JF, Van Orman C (2006) Development of performance indicators for the primary care management of paediatric epilepsy: expert consensus recommendations based on the available evidence. Epilepsia 47:2011–2019PubMedCrossRefGoogle Scholar
  16. 16.
    Jones J, Hunter D (1995) Consensus methods for medical and health services research. BMJ 311:376–380PubMedGoogle Scholar
  17. 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
  18. 18.
    Shelton PS, Fritsch MA, Scott MA (2000) Assessing medication appropriateness in the elderly. A review of available measures. Drugs Aging 16:437–450PubMedCrossRefGoogle Scholar
  19. 19.
    Swagerty D, Brickley R (2005) American medical directors association and American society of consultant pharmacists joint position statement on the Beers list of potentially inappropriate medications in older adults. J Am Med Dir Assoc 6:80–86PubMedCrossRefGoogle Scholar
  20. 20.
    Egger SS, Bachmann A, Hubmann N, Schlienger RG, Krähenbühl S (2006) Prevalence of potentially inappropriate medication use in elderly patients. Comparison between general medical and geriatric wards. Drugs Aging 23:823–837PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Marie-Laure Laroche
    • 1
  • Jean-Pierre Charmes
    • 2
  • Louis Merle
    • 1
    Email author
  1. 1.Department of Pharmacology-Toxicology, Centre of PharmacovigilanceUniversity Hospital DupuytrenLimogesFrance
  2. 2.Department of GeriatricsHospital RebeyrolLimogesFrance

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