Prevalence of potentially inappropriate prescribing in an acutely ill population of older patients admitted to six European hospitals

  • Paul Gallagher
  • Pierre Olivier Lang
  • Antonio Cherubini
  • Eva Topinková
  • Alfonso Cruz-Jentoft
  • Beatriz Montero Errasquín
  • Pavla Mádlová
  • Beatrice Gasperini
  • Hilde Baeyens
  • Jean-Pierre Baeyens
  • Jean-Pierre Michel
  • Denis O’Mahony
Pharmacoepidemiology and Prescription

Abstract

Purpose

Potentially inappropriate prescribing is common in older people presenting to hospital with acute illness in Ireland. The aim of this study was to determine if this phenomenon is unique to Ireland or whether it is a more widespread problem in hospitals across Europe.

Methods

Prospective data were collected from 900 consecutive older patients admitted to six university teaching hospitals (150 patients per centre) in Geneva (Switzerland), Madrid (Spain), Oostende (Belgium), Perugia (Italy), Prague (Czech Republic) and Cork (Ireland). Age, gender, comorbidity, cognitive status, prescription medicines taken before admission and baseline haematological, biochemical and electrocardiographic data were recorded. STOPP and Beers’ criteria were applied to detect potentially inappropriate medicines (PIMs). START criteria were applied to detect potentially inappropriate prescribing omissions (PPOs).

Results

The overall PIM prevalence rate was 51.3% using STOPP criteria, varying from 34.7% in Prague to 77.3% in Geneva, and 30.4% using Beer’s criteria, varying from 22.7% in Prague to 43.3% in Geneva. Using START criteria, the overall PPO prevalence rate was 59.4%, ranging from 51.3% in Cork to 72.7% in Perugia. Polypharmacy predicted the presence of PIMs using STOPP criteria [with >10 medications: odds ratio (OR)  7.22, 95% confidence interval (CI) 4.30–12.12, p < 0.001] and Beers’ criteria (with >10 medications: OR 4.87, 95% CI 3.00–7.90, p < 0.001). Increasing co-morbidity (Charlson Index ≥2) and age ≥85 years significantly predicted PPOs.

Conclusion

Potentially inappropriate drug prescribing and the omission of beneficial drugs are highly prevalent in acutely ill hospitalized older people in six European centres.

Keywords

Inappropriate prescribing Elderly STOPP/START Beers’ criteria 

Notes

Funding

The Health Research Board of Ireland (Clinical Research Training Fellowship CRT/2006/029) and the Czech Ministry of Health Internal Grant Agency (NS/10029-4/2008) provided financial support for this study.

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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Paul Gallagher
    • 1
  • Pierre Olivier Lang
    • 2
  • Antonio Cherubini
    • 3
  • Eva Topinková
    • 4
  • Alfonso Cruz-Jentoft
    • 5
  • Beatriz Montero Errasquín
    • 5
  • Pavla Mádlová
    • 4
  • Beatrice Gasperini
    • 3
  • Hilde Baeyens
    • 6
  • Jean-Pierre Baeyens
    • 7
  • Jean-Pierre Michel
    • 2
  • Denis O’Mahony
    • 1
  1. 1.Department of Geriatric MedicineCork University HospitalWilton, CorkIreland
  2. 2.Rehabilitation and Geriatric DepartmentGeneva Medical School and University HospitalsGenevaSwitzerland
  3. 3.Department of Clinical and Experimental Medicine, Institute of Gerontology and GeriatricsUniversity of Perugia Medical SchoolPerugiaItaly
  4. 4.Department of Geriatric Medicine, First Faculty of MedicineCharles UniversityPragueCzech Republic
  5. 5.Department Servicio de GeriatríaHospital Universitario Ramón y CajalMadridSpain
  6. 6.Department of Geriatric MedicineAZ AlmaEekloBelgium
  7. 7.Department of Geriatric MedicineAZ DamiaanOostendeBelgium

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