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International Journal of Clinical Pharmacy

, Volume 39, Issue 1, pp 113–119 | Cite as

Potentially inappropriate prescribing in a population of frail elderly people

  • Isabelle RécochéEmail author
  • Cécile LebaudyEmail author
  • Charlène Cool
  • Sandrine Sourdet
  • Antoine Piau
  • Maryse Lapeyre-Mestre
  • Bruno Vellas
  • Philippe Cestac
Research Article

Abstract

Background Frailty is a clinical syndrome highly predictive of functional decline after a stress or a medical event, such as adverse drug events. Objective To describe the prevalence of potentially inappropriate prescribing in a population of frail elderly patients. Setting Geriatric day hospital for assessment of frailty and prevention of disability, Toulouse, France. Method A cross-sectional study performed from January to April 2014. Two pharmacists retrospectively analyzed the prescriptions of elderly patients who were sent to the day hospital to assess their frailty and to be given a personalized plan of care and prevention. Potentially inappropriate prescribing was defined by combining explicit criteria: Laroche list, screening tool of older people’s prescriptions, and screening tool to alert to right treatment with an implicit method (drug utilization review for each medication). Prescriptions’ optimizations were then suggested to the geriatricians of the day hospital and classified according to criteria defined by the French Society of Clinical Pharmacy. Main outcome measure Prevalence of potentially inappropriate prescribing. Results Among the 229 patients included, 71.2% had potentially inappropriate prescribing. 76 patients (33.2%) had at least one drug without any valid indication. 51 (22.3%) had at least one drug with an unfavorable benefit-to-risk ratio according to their clinical and biological data, 42 (18.3%) according to the Laroche list and 38 (16.6%) had at least one drug with questionable efficacy. Conclusion Our work shows that the incidence of PIP is high in the frail elderly and that, in most cases, it could be avoided with an adequate and regular reassessment of the prescriptions. In future, prescription optimization will be integrated into the personalized medical care plan to further prevent drug-related disability.

Keywords

Adverse drug event Drug therapy Frail elderly France Inappropriate prescribing 

Notes

Acknowledgements

We would like to thank members of the team of the “geriatric frailty clinic for assessment of frailty and prevention of disability”.

Funding

None

Conflicts of interest

Bruno Vellas is a Scientific Board Member of Biogen, GSK, Lilly, Lundbeck, Medivation, MSD, Nestlé, Nutricia, Pfizer, Roche, Sanofi, Servier, TauRx Therapeutics, Alzhéon, Transition Therapeutics, Takeda and received Gerontopôle Research Grants from Abbvie, Affiris, Avid, BMS, Eisai, Elan, Envivo, Exhonit, Genentech, GSK, Ipsen, Lilly, Lundbeck, Médivation, MSD, Nutricia, Otsuka, Pharnext, Pfizer, Pierre-Fabre, Régénéron, Roche, Sanofi, Servier, TauRx Therapeutics, Wyeth, Astra-Zénéca, LPG Systems. All the others authors have no conflict of interest to declare.

References

  1. 1.
    Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A. 2001;56:M146–56.CrossRefGoogle Scholar
  2. 2.
    Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G. Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A. 2004;59:255–63.CrossRefGoogle Scholar
  3. 3.
    Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. 2013;381:752–62.CrossRefPubMedGoogle Scholar
  4. 4.
    Tavassoli N, Guyonnet S, Abellan Van Kan G, Sourdet S, Krams T, Soto ME, et al. Description of 1,108 older patients referred by their physician to the “Geriatric Frailty Clinic (G.F.C) for Assessment of Frailty and Prevention of Disability” at the gerontopole. J Nutr Health Aging. 2014;18:457–64.CrossRefPubMedGoogle Scholar
  5. 5.
    Morley JE, Vellas B, van Kan GA, Anker SD, Bauer JM, Bernabei R, et al. Frailty consensus: a call to action. J Am Med Dir Assoc. 2013;14:392–7.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Gnjidic D, Hilmer SN, Blyth FM, Naganathan V, Cumming RG, Handelsman DJ, et al. High-risk prescribing and incidence of frailty among older community-dwelling men. Clin Pharmacol Ther. 2012;91:521–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Landi F, Russo A, Liperoti R, Barillaro C, Danese P, Pahor M, et al. Impact of inappropriate drug use on physical performance among a frail elderly population living in the community. Eur J Clin Pharmacol. 2007;63:791–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Spinewine A, Schmader KE, Barber N, Hughes C, Lapane KL, Swine C, et al. Appropriate prescribing in elderly people: how well can it be measured and optimised? Lancet. 2007;370:173–84.CrossRefPubMedGoogle Scholar
  9. 9.
    O’Mahony D, Gallagher PF. Inappropriate prescribing in the older population: need for new criteria. Age Ageing. 2008;37:138–41.CrossRefPubMedGoogle Scholar
  10. 10.
    By the American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American Geriatrics Society. Updated beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2015;2015(63):2227–46.Google Scholar
  11. 11.
    O’Mahony D, O’Sullivan D, Byrne S, O’Connor MN, Ryan C, Gallagher P. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing. 2015;44:213–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Laroche M-L, Charmes J-P, Merle L. Potentially inappropriate medications in the elderly: a French consensus panel list. Eur J Clin Pharmacol. 2007;63:725–31.CrossRefPubMedGoogle Scholar
  13. 13.
    Vellas B, Balardy L, Gillette-Guyonnet S, Abellan Van Kan G, Ghisolfi-Marque A, Subra J, et al. Looking for frailty in community-dwelling older persons: the Gérontopôle Frailty Screening Tool (GFST). J Nutr Health Aging. 2013;17:629–31.CrossRefPubMedGoogle Scholar
  14. 14.
    Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of illness in the aged. The index of adl: a standardized measure of biological and psychosocial function. J Am Med Assoc. 1963;185:914–9.CrossRefGoogle Scholar
  15. 15.
    World Health Organization Collaborating Centre for Drug Statistics Methodology. Guidelines for ATC classification and DDD assignement [Internet]. [cited 2016 September 2]. http://www.whocc.no/atc_ddd_index/.
  16. 16.
    Allenet B, Bedouch P, Rose F-X, Escofier L, Roubille R, Charpiat B, et al. Validation of an instrument for the documentation of clinical pharmacists’ interventions. Pharm World Sci. 2006;28:181–8.CrossRefPubMedGoogle Scholar
  17. 17.
    Cool C, Cestac P, Laborde C, Lebaudy C, Rouch L, Lepage B, et al. Potentially inappropriate drug prescribing and associated factors in nursing homes. J Am Med Dir Assoc. 2014;15(850):e1–9.Google Scholar
  18. 18.
    Fialová D, Topinková E, Gambassi G, Finne-Soveri H, Jónsson PV, Carpenter I, et al. Potentially inappropriate medication use among elderly home care patients in Europe. J Am Med Assoc. 2005;293:1348–58.CrossRefGoogle Scholar
  19. 19.
    Lechevallier-Michel N, Gautier-Bertrand M, Alpérovitch A, Berr C, Belmin J, Legrain S, et al. Frequency and risk factors of potentially inappropriate medication use in a community-dwelling elderly population: results from the 3C Study. Eur J Clin Pharmacol. 2005;60:813–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Bongue B, Laroche ML, Gutton S, Colvez A, Guéguen R, Moulin JJ, et al. Potentially inappropriate drug prescription in the elderly in France: a population-based study from the French National Insurance Healthcare system. Eur J Clin Pharmacol. 2011;67:1291–9.CrossRefPubMedGoogle Scholar
  21. 21.
    Hayes BD, Klein-Schwartz W, Barrueto F. Polypharmacy and the geriatric patient. Clin Geriatr Med. 2007;23:371–90.CrossRefPubMedGoogle Scholar
  22. 22.
    Bennett A, Gnjidic D, Gillett M, Carroll P, Matthews S, Johnell K, et al. Prevalence and impact of fall-risk-increasing drugs, polypharmacy, and drug-drug interactions in robust versus frail hospitalised falls patients: a prospective cohort study. Drugs Aging. 2014;31:225–32.CrossRefPubMedGoogle Scholar
  23. 23.
    Hanlon JT, Schmader KE, Ruby CM, Weinberger M. Suboptimal prescribing in older inpatients and outpatients. J Am Geriatr Soc. 2001;49:200–9.CrossRefPubMedGoogle Scholar
  24. 24.
    Sheen E, Triadafilopoulos G. Adverse effects of long-term proton pump inhibitor therapy. Dig Dis Sci. 2011;56:931–50.CrossRefPubMedGoogle Scholar
  25. 25.
    Queneau P, Bannwarth B, Carpentier F, Guliana J-M, Bouget J, Trombert B, et al. Emergency department visits caused by adverse drug events: results of a French survey. Drug Saf. 2007;30:81–8.CrossRefPubMedGoogle Scholar
  26. 26.
    Fayssoil A, Issi J, Guerbaa M, Raynaud J-C, Heroguelle V. Torsade de pointes induite par l’association citalopram et amiodarone [Torsade de pointes induced by citalopram and amiodarone]. Ann Cardiol Angéiol. 2011;60:165–8.CrossRefGoogle Scholar
  27. 27.
    Lakey SL, LaCroix AZ, Gray SL, Borson S, Williams CD, Calhoun D, et al. Antidepressant use, depressive symptoms, and incident frailty in women aged 65 and older from the Women’s Health Initiative Observational Study. J Am Geriatr Soc. 2012;60:854–61.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Schmader KE, Hanlon JT, Pieper CF, Sloane R, Ruby CM, Twersky J, et al. Effects of geriatric evaluation and management on adverse drug reactions and suboptimal prescribing in the frail elderly. Am J Med. 2004;116:394–401.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing 2016

Authors and Affiliations

  • Isabelle Récoché
    • 1
    Email author
  • Cécile Lebaudy
    • 1
    Email author
  • Charlène Cool
    • 1
    • 2
  • Sandrine Sourdet
    • 2
    • 3
  • Antoine Piau
    • 3
  • Maryse Lapeyre-Mestre
    • 2
    • 4
  • Bruno Vellas
    • 2
    • 3
  • Philippe Cestac
    • 1
    • 2
  1. 1.Department of PharmacyCentre Hospitalier Universitaire de ToulouseToulouse Cedex 9France
  2. 2.UMR INSERM 1027University of Toulouse IIIToulouseFrance
  3. 3.Department of Geriatric Medicine University HospitalToulouse Cedex 9France
  4. 4.Department of PharmacologyUniversity HospitalToulouseFrance

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