Pharmacy World and Science

, Volume 28, Issue 5, pp 296–301 | Cite as

Inappropriate drug use by Portuguese elderly outpatients – effect of the Beers criteria update

  • Sofia de Oliveira MartinsEmail author
  • Maria Augusta Soares
  • J. W. Foppe van Mil
  • José Cabrita
Research Article



To characterize the use of medicines and to evaluate the inappropriateness of drugs in elderly outpatient population.


Twelve community pharmacies in different districts of Lisbon – Portugal.


Observational cross-sectional survey, in a sample of 213 elderly outpatients (age ≥ 65-years-old) presenting a prescription with two or more drugs, for their own use.

Main outcome measures

Drug use pattern and prevalence of potentially inappropriate medication.


We have studied 213 outpatients, who were taking a total of 1,543 drugs, with an average of 7.23 per patient. The drugs were distributed mainly in the following 3 ATC (Anatomical Therapeutic Chemical Classification) classes: C (cardiovascular system), N (nervous system) and A (alimentary tract). Using the 1997 Beers Explicit criteria, 75 occurrences of inappropriate medicines were detected in 59 patients (27.7%), while with the 2003 Beers Explicit criteria we detected 114 cases of inappropriate medication in 82 patients (38.5%). The occurrence of inappropriate medicines was significantly associated with the consumption of a high number of drugs. According to the ATC Classification, more than one half of the cases of inappropriateness were related with long acting benzodiazepines and with ticlopidine. The 2003 version detected a significantly higher prevalence of inappropriate drug use having potentially adverse outcomes of high severity.


The application of the updated Beers criteria lead to higher rates of potentially inappropriate medication, and especially those responsible for more severe adverse outcomes. The results suggest that there is a need for interventions to improve instructions for safe drug use in the elderly patients and to decrease the number of medications whenever it is possible. This study suggests a high prevalence of potentially inappropriate drug use by the elderly patients of Lisbon region, Portugal.


Beers criteria Drug use evaluation Elderly Inappropriate drug use Inappropriate prescriptions Outpatients Portugal 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.



The authors acknowledge the pharmacy students for their participation in this study and Filipa Duarte Ramos for the review and critical comments on this manuscript. We especially acknowledge Dennis Helling, Executive Director of Pharmacy Operations and Therapeutics from Kaiser Permanente, Colorado Region and Adjoint Professor, University of Colorado School of Pharmacy, for the review of the final version.


  1. 1.
    Rancourt C, Moisan J, Baillargeon L, Verreault R, Laurin D, Gregoire JP. Potentially inappropriate prescriptions for older patients in long-term care. BMC Geriatr 2004;4:9PubMedCrossRefGoogle Scholar
  2. 2.
    Schmader K, Hanlon JT, Weinberger M, Landsman PB, Samsa GP, Lewis I, et al. Appropriateness of medicines prescribing in ambulatory elderly patients. J Am Geriatr Soc 1994;42(12):1241–7PubMedGoogle Scholar
  3. 3.
    Hanlon JT, Schmader KE, Koronkowski MJ, Weinberger M, Landsman PB, Samsa GP, et al. Adverse drug events in␣high-risk older outpatients. J Am Geriatr Soc 1997;45:945–8PubMedGoogle Scholar
  4. 4.
    Mannesse CK, Derkx FHM, De Ridder MAJ, Veld AJM, Van der Cammen TJM Contribution of adverse drug reactions to hospital admission of older patients. Age Ageing 2000;29:35–9PubMedCrossRefGoogle Scholar
  5. 5.
    Vlahovic-Palcevski V, Bergman U. Quality of prescribing for the elderly in Croatia – computerized pharmacy data can be used to screen for potentially inappropriate prescribing. Eur J Clin Pharmacol 2004;60:217–20PubMedCrossRefGoogle Scholar
  6. 6.
    Hanlon JT, Schmader KE, Boult C, Artz MB, Cross CR, Fillenbaum GG, et al. Use of inappropriate prescription drugs by older people. J Am Geriatr Soc 2002;50:26–34PubMedCrossRefGoogle Scholar
  7. 7.
    Beers MD. Explicit criteria for determining potentially inappropriate medicines use by the elderly. Arch Intern Med 2002;157:1531–6CrossRefGoogle Scholar
  8. 8.
    McLeod PJ, Huang AR, Tamblyn RM, Gayton DC. Defining inappropriate practices in prescribing for elderly people: a National Consensus panel. CMAJ J 1997;156(3):385–91Google Scholar
  9. 9.
    Hanlon JT, Schmader KE, Samsa GP, Weinberger M, Uttech KM, Lewis IK, et al. A method for assessing drug␣therapy appropriateness. J Clin Epidemiol 1992;45(10):1045–51PubMedCrossRefGoogle Scholar
  10. 10.
    Beers MH, Ouslander JG, Rollinger I, Reuben D, Beck JC. Explicit criteria for determining inappropriate medicines use␣in nursing home residents. Arch Intern Med 1991;151:1825–32PubMedCrossRefGoogle Scholar
  11. 11.
    Fick DM, Cooper JW, Wade WE, Waller JL, Maclean JR, Beers MH. Updating the Beers criteria for potentially inappropriate medicines use in older adults. Arch Intern Med 2003;163:2716–24PubMedCrossRefGoogle Scholar
  12. 12.
    Lui GG, Christensen DB. The continuing challenge of inappropriate prescribing in the elderly: an update of the evidence. J Am Pharm Assoc 2002;42(6):847–57CrossRefGoogle Scholar
  13. 13.
    Huang B, Bachmann KA, He X, Chen R, McAllister JS, Wang T. Inappropriate prescriptions for the aging population of the United States: an analysis of the National Ambulatory Medical Care Survey. Pharmacoepidemiol Drug Saf 2002;11:127–34PubMedCrossRefGoogle Scholar
  14. 14.
    Hanlon JT, Lindblad CI, Hajjar ER, McCarthy TC. Update on Drug-related problems in the elderly. Am J Geriatr Pharmacoth 2003;1(1):38–43CrossRefGoogle Scholar
  15. 15.
    Stuart B, Kamal-Bahl S, Briesacher B, Lee E, Doshi J, Zucherman IH, et al. Trends in the prescription of inappropriate drugs for the elderly between 1995 and 1999. Am J␣Geriatr Pharmacother 2003;1(2):61–74PubMedCrossRefGoogle Scholar
  16. 16.
    World Health Organisation. Guidelines for ATC Classification. WHO Collaborating Centre for Drug Statistics Methodology, Oslo, Norway; 2002Google Scholar
  17. 17.
    Laurier C, Moride Y, Kennedy WA. Health survey data on potentially inappropriate geriatric drug use. Ann Pharmacother 2002;36:404–9PubMedCrossRefGoogle Scholar
  18. 18.
    Heininger-Rothbucher D, Daxecker M, Ulmer H, Gritsch W, Pechlaner C, Wiedermann CJ. Problematic drugs in elderly patients presenting to a European emergency room. Eur J Intern Med 2003;14:372–6PubMedCrossRefGoogle Scholar
  19. 19.
    Piecoro LT, Browning SR, Prince TS, Scutchfield FD, Ranz TT. A database analysis of potentially inappropriate drug use in an elderly Medicaid population. Pharmacotherapy 2000;20(2):221–8PubMedCrossRefGoogle Scholar
  20. 20.
    Spiker EC, Emptage RE, Giannamore MR, Pedersen CA. Potential adverse drug events in an indigent and homeless geriatric population. Ann Pharmacother 2001;35(10):1166–72PubMedCrossRefGoogle Scholar
  21. 21.
    Mott DA, Meek PD. Evaluating prescriptions for the elderly: drug/age criteria as help community pharmacists. J Am Pharm Ass (Wash) 2000;40(3):417–24Google Scholar
  22. 22.
    Mort JR, Aparasu RR. Prescribing potentially inappropriate psychotropic medicines to the ambulatory elderly. Arch Intern Med 2000;160:2825–31PubMedCrossRefGoogle Scholar
  23. 23.
    Bartlett G, Abrahamowicz M, Tamblyn R, Grad R, Capek R, Berger R. Longitudinal patterns of new benzodiazepine use in the elderly. Pharmacoepidemiol Drug Saf 2004;13:669–82PubMedCrossRefGoogle Scholar
  24. 24.
    Kirby M, Denihan A, Bruce I, Radic A, Coakley D, Lawlor BA. Benzodiazepine use among the elderly in the community. Int J Geriat Psychiatry 1999;14:280–4CrossRefGoogle Scholar
  25. 25.
    Association of Self-Medication Industry. Economic and Legal Framework for Non-Prescription Medicines. AESGP, June 2005Google Scholar
  26. 26.
    Fu AZ, Lui GG, Christensen DB. Inappropriate medicines use and health outcomes in the elderly. J Am Geriatr Soc 2004;52(11):1934–9PubMedCrossRefGoogle Scholar
  27. 27.
    Monane M, Mattias DM, Nagie BA, Kelly MA. Improving prescribing patterns for the elderly through an online drug utilization review intervention. JAMA 1998;280(14):1249–52PubMedCrossRefGoogle Scholar
  28. 28.
    Bjorkman IK, Fastborn J, Schmidt IK, Bernsten CB. Drug–drug interactions in the elderly. Ann Pharmacother 2002;36:1675–81PubMedCrossRefGoogle Scholar
  29. 29.
    Hanlon JT. Drug related problems updates. Am J Geriatr Pharmacoth 2004;2:88–90CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2006

Authors and Affiliations

  • Sofia de Oliveira Martins
    • 1
    Email author
  • Maria Augusta Soares
    • 1
  • J. W. Foppe van Mil
    • 2
  • José Cabrita
    • 1
  1. 1.Faculty of PharmacyUniversity of LisbonLisbonPortugal
  2. 2.van Mil ConsultancyZuidlarenThe Netherlands

Personalised recommendations