Current Psychiatry Reports

, Volume 10, Issue 1, pp 37–43 | Cite as

Inappropriate prescribing in geriatric patients



Inappropriate prescribing in older people is a common condition associated with significant morbidity, mortality, and financial costs. Medication use increases with age, and this, in conjunction with an increasing disease burden, is associated with adverse drug reactions. This review outlines why older people are more likely to develop adverse drug reactions and how common the problem is. The use of different tools to identify and measure the problem is reviewed. Common syndromes seen in older adults (eg, falling, cognitive impairment, sleep disturbance) are considered, and recent evidence in relation to medication use for these conditions is reviewed. Finally, we present a brief summary of significant developments in the recent literature for those caring for older people.


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References and Recommended Reading

  1. 1.
    Golden AG, Preston RA, Barnett SD, et al.: Inappropriate prescribing in homebound older adults. J Am Geriatr Soc 1999, 47:948–953PubMedGoogle Scholar
  2. 2.
    O’Connor K, O’Mahony D: Drugs and ageing. In Medicine for Older Patients: Cases and Practice. Edited by Liston R, Mulkerrin EC. Dublin, Ireland: Eireann Healthcare Publications; 2003:205.Google Scholar
  3. 3.
    Kaufman DW, Kelly JP, Rosenberg L, et al.: Recent patterns of medication use in the ambulatory adult population of the United States: the Slone Survey. JAMA 2002, 287:337.PubMedCrossRefGoogle Scholar
  4. 4.
    Everitt DE, Avorn J: Drug prescribing for the elderly. Arch Intern Med 1986, 146:2393–2396.PubMedCrossRefGoogle Scholar
  5. 5.
    Mangoni AA, Jackson SH: Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications. Br J Clin Pharmacol 2003, 57:6–14.CrossRefGoogle Scholar
  6. 6.
    Hunt CM, Westerkam WR, Stave GM: Effect of age and gender on the activity of human hepatic CYP3A. Biochem Pharmacol 1992, 44:275.PubMedCrossRefGoogle Scholar
  7. 7.
    Swift CG, Ewen JM, Clarke P, Stephenson IH: Responsiveness to oral diazepam in the elderly: relationship to total and free plasma concentrations. Br J Clin Pharmacol 1985, 20:111–118.PubMedGoogle Scholar
  8. 8.
    Maixner SM, Mellow AM, Tandon R: The efficacy, safety and tolerability of antipsychotics in the elderly. J Clin Psychiatry 1999, 60:29–41.PubMedCrossRefGoogle Scholar
  9. 9.
    Col N, Fanale JE, Kronholm P: The role of medication noncompliance and adverse drug reactions in hospitalizations of the elderly. Arch Intern Med 1990, 150:841–845.PubMedCrossRefGoogle Scholar
  10. 10.
    Hanlon JT, Schmader KE, Kornkowski MJ, et al.: Adverse drug events in high risk older outpatients. J Am Geriatr Soc 1997, 45:945–948.PubMedGoogle Scholar
  11. 11.
    Lindley CM, Tully MP, Paramsothy V, et al.: Inappropriate medication is a major cause of adverse drug reactions in elderly patients. Age Ageing 1992, 21:294–300.PubMedCrossRefGoogle Scholar
  12. 12.
    Cooper JW: Adverse drug reaction-related hospitalizations of nursing-facility patients: a 4 year study. South Med J 1999, 92:485–490.PubMedCrossRefGoogle Scholar
  13. 13.
    Fick DM, Cooper JW, Wade WE, et al.: Updating the Beers criteria for potentially inappropriate medication use in older adults—results of a US consensus panel of experts. Arch Intern Med 2003, 163:2716–2724.PubMedCrossRefGoogle Scholar
  14. 14.
    McLeod PJ, Huang AR, Tamblyn RN, Gayton DC: Defining inappropriate practices in prescribing for elderly people: a national consensus panel. CMAJ 1997, 156:385–391.PubMedGoogle Scholar
  15. 15.
    Naugler CT, Brymer C, Stolee P, Arcese ZA: Development and validation of an improved prescribing for the elderly tool. Can J Clin Pharmacol 2000, 7:103–107.PubMedGoogle Scholar
  16. 16.
    Laroche ML, Charmes JP, Merle L: Potentially inappropriate medications in the elderly: a French consensus panel list. Eur J Clin Pharmacol 2007, 63:725–731.PubMedCrossRefGoogle Scholar
  17. 17.
    Oborne CA, Hooper R, Swift CG, Jackson SH: Explicit, evidence-based criteria to assess the quality of prescribing to elderly nursing home residents. Age Ageing 2003, 32:102–108.PubMedCrossRefGoogle Scholar
  18. 18.
    Liu GG, Christensen DB: The continuing challenge of inappropriate prescribing in the elderly: an update of the evidence. J Am Pharm Assoc (Wash) 2002, 42:847–857.CrossRefGoogle Scholar
  19. 19.
    Pitkala KH, Strandberg TE, Tilvis RS: Inappropriate drug prescribing in home-dwelling elderly patients: a population based survey. Arch Intern Med 2002, 162:1707–1712.PubMedCrossRefGoogle Scholar
  20. 20.
    Hanlon JT, Schmader KE, Samsa GP, et al.: A method for assessing drug therapy appropriateness. J Clin Epidemiol 1992, 45:1045–1051.PubMedCrossRefGoogle Scholar
  21. 21.
    Jeffrey S, Ruby C, Tverlisky J, et al.: Effect of an interdisciplinary team on suboptimal prescribing in a long-term care facility. Consult Pharm 1999, 14:1386–1391.Google Scholar
  22. 22.
    Hanlon JT, Artz MB, Pieper CF, et al.: Inappropriate medication use among frail elderly inpatients. Ann Pharmacother 2004, 38:9–14.PubMedCrossRefGoogle Scholar
  23. 23.
    Higashi T, Shekelle PG, Solomon DH: The quality of pharmacologic care for vulnerable older patients. Ann Intern Med 2004, 140:714–720.PubMedGoogle Scholar
  24. 24.
    Spinewine A, Schmader KE, Barber N, et al.: Appropriate prescribing in elderly people: how well can it be measured and optimised? Lancet 2007, 370:173–184.PubMedCrossRefGoogle Scholar
  25. 25.
    Lord SR, Anstey KJ, Williams P, et al.: Psychoactive medication use, sensory motor function and falls in older women. Br J Clin Pharmacol 1995, 39:227–234.PubMedGoogle Scholar
  26. 26.
    Souchet E, Lapeyre-Mestre M, Montastruc JL: Drug related falls: a study in the French Pharmacovigilance database. Pharmacoepidemiol Drug Saf 2005, 14:11–16.PubMedCrossRefGoogle Scholar
  27. 27.
    Kamal-Bahl SJ, Stuart BC, Beers MH: Propoxyphene use and risk for hip fracture in older adults. Am J Geriatr Pharmacother 2006, 4:219–226.PubMedCrossRefGoogle Scholar
  28. 28.
    Crotty M, Rowett D, Spurling L, et al.: Does the addition of a pharmacist transition coordinator improve evidence-based medication management and health outcomes in older adults moving from the hospital to a long-term care facility? Results of a randomized, controlled trial. Am J Geriatr Pharmacother 2004, 2:25–64.CrossRefGoogle Scholar
  29. 29.
    Herzog AR, Fultz NH: Prevalence and incidence of urinary incontinence in community dwelling populations. J Am Geriatr Soc 1990, 38:273–281.PubMedGoogle Scholar
  30. 30.
    Wagner TH, Hu TW: Economic costs of urinary incontinence in 1995. Urology 1998, 51:355–361.PubMedCrossRefGoogle Scholar
  31. 31.
    Hay-Smith J, Herbison P, Ellis G, et al.: Which anticholinergic drug for overactive bladder symptoms in adults. Cochrane Database Syst Rev 2005, 3:CD005429.PubMedGoogle Scholar
  32. 32.
    Gill SS, Mamdani M, Naglie G, et al.: A prescribing cascade involving cholinesterase inhibitors and anticholinergic drugs. Arch Intern Med 2005, 165:808–813.PubMedCrossRefGoogle Scholar
  33. 33.
    Gahimer J, Wernicke J, Yalcin I, et al.: A retrospective pooled analysis of duloxetine safety in 23,983 subjects. Curr Med Res Opin 2007, 23:175–184.PubMedCrossRefGoogle Scholar
  34. 34.
    Wang PS, Schneeweiss S, Avorn J, et al.: Risk of death in elderly users of conventional vs. atypical antipsychotic medications. N Engl J Med 2005, 353:2335–2341.PubMedCrossRefGoogle Scholar
  35. 35.
    Bullock R: Treatment of behavioral and psychiatric symptoms in dementia: implications of recent safety warnings. Curr Med Res Opin 2005, 21:1–10.PubMedCrossRefGoogle Scholar
  36. 36.
    Zanocchi M, Tibaldi V, Amati D, et al.: Adverse drug reactions as a cause of visits to the emergency department: incidence, features and outcome [in Italian]. Recenti Prog Med 2006, 97:381–388.PubMedGoogle Scholar
  37. 37.
    Galatti L, Giustini SE, Sessa A, et al.: Neuropsychiatric reactions to drugs: an analysis of spontaneous reports from general practitioners in Italy. Pharmacol Res 2005, 51:211–216.PubMedCrossRefGoogle Scholar
  38. 38.
    Karacan I, Thornby JT, Williams RL: Sleep disturbance: a community survey. In Sleep/Wake Disorders: A Natural History, Epidemiology and Long Term Evolution. Edited by Guilleminault C, Lugaresi E. New York: Raven Press; 1983:37–60.Google Scholar
  39. 39.
    Huang WF, Lai IC: Potentially inappropriate prescribing for insomnia in elderly outpatients in Taiwan. Int J Clin Pharmacol Ther 2006, 44:335–342.PubMedGoogle Scholar
  40. 40.
    Swegle JM, Logemann C: Management of common opioid side effects. Am Fam Physician 2006, 74:1347–1354.PubMedGoogle Scholar
  41. 41.
    Heading R, Bardhan K, Hollerbach S, et al.: Systematic review: the safety and tolerability of pharmacological agents for treatment of irritable bowel syndrome—a European perspective. Aliment Pharmacol Ther 2006, 24:207–236.PubMedCrossRefGoogle Scholar
  42. 42.
    Currow DC, Stevenson JP, Abernethy AP, et al.: Prescribing in palliative as death approaches. J Am Geriatr Soc 2007, 55:590–595.PubMedCrossRefGoogle Scholar
  43. 43.
    Ratz Bravo AE, Tchambaz L, Krahenbuhl-Melcher A, et al.: Prevalence of potentially severe drug-drug interactions in ambulatory patients with dyslipidaemia receiving HMG-CoA reductase inhibitor therapy. Drug Saf 2005, 28:263–275.PubMedCrossRefGoogle Scholar
  44. 44.
    Muldoon MF, Ryan CM, Sereika SM, et al.: Randomized trial of the effects of simvastatin on cognitive functioning in hypercholesterolemic adults. Am J Med 2004, 117:823–829.PubMedCrossRefGoogle Scholar
  45. 45.
    Tatley M, Savage R: Psychiatric adverse reactions with statins, fibrates and ezetimibe. Drug Saf 2007, 30:195–201.PubMedCrossRefGoogle Scholar
  46. 46.
    Ko DT, Juurlink DN, Mamdani MM, et al.: Appropriateness of spironolactone prescribing in heart failure patients: a population-based study. J Card Fail 2006, 12:205–210.PubMedCrossRefGoogle Scholar
  47. 47.
    Gallelli L, Colosimo M, Pirritano D, et al.: Retrospective evaluation of adverse drug reactions induced by nonsteroidal anti-inflammatory drugs. Clin Drug Investig 2007, 27:115–122.PubMedCrossRefGoogle Scholar
  48. 48.
    Bresalier RS, Sandler RS, Quan H, et al.: Cardiovascular events associated with rofecoxib in a colorectal adenoma chemoprevention trial. N Engl J Med 2005, 352:1092–1102.PubMedCrossRefGoogle Scholar
  49. 49.
    Nissen SE, Wolski K: Effects of rosiglitazone on the risk of myocardial infarction and death from cardiovascular causes. N Engl J Med 2007, 356:2457–2471.PubMedCrossRefGoogle Scholar
  50. 50.
    Home PD, Pocock SJ, Beck-Nielsen H, et al.: Rosiglitazone evaluated for cardiovascular outcomes-an interim analysis. N Engl J Med 2007, 357:28–38.PubMedCrossRefGoogle Scholar

Copyright information

© Current Medicine Group LLC 2008

Authors and Affiliations

  1. 1.Department of Geriatric MedicineCork University HospitalWilton, CorkIreland

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