Skip to main content

Advertisement

SpringerLink
Log in

Prevalence of Potentially Inappropriate Medication Use in Elderly Patients

Comparison between General Medical and Geriatric Wards

  • Original Research Article
  • Published:
Drugs & Aging Aims and scope Submit manuscript

Abstract

Background and objective

Inappropriate drug use is one of the risk factors for adverse drug reactions in the elderly. We hypothesised that, in elderly patients, geriatricians are more aware of potentially inappropriate medications (PIMs) and may replace or stop PIMs more frequently compared with internists. We therefore evaluated and compared the prevalence of PIMs as well as anticholinergic drug use throughout hospital stay in elderly patients admitted to a medical or geriatric ward.

Methods

In this retrospective cross-sectional study, 800 patients aged ≥65 years admitted to a general medical or geriatric ward of a 700-bed teaching hospital in Switzerland during 2004 were included. PIMs were identified using the Beers criteria published in 2003. The prevalence of anticholinergic drug use was assessed based on drug lists published in the literature.

Results

The prevalence of use of PIMs that should generally be avoided was similar in medical and geriatric inpatients both at admission (16.0% vs 20.8%, respectively; p = 0.08) and at discharge (13.3% vs 15.9%, respectively; p = 0.31). In contrast to medical patients, the reduction in the prevalence of use of PIMs between admission and discharge in geriatric patients reached statistical significance (p < 0.05). Overall, the three most prevalent inappropriate drugs/drug classes were amiodarone, long-acting benzodiazepines and anticholinergic antispasmodics. At admission, the prevalence of use of PIMs related to a specific diagnosis was not significantly different between patients hospitalised to a medical or a geriatric ward (14.0% vs 17.5%, respectively; p = 0.17), as compared with the significant difference evident at hospital discharge (11.7% vs 23.7%, respectively; p < 0.001). This was largely because of ahigher prescription rate of platelet aggregation inhibitors in combination with low-molecular-weight heparins and benzodiazepines in patients with a history of falls and syncope. The proportions of patients taking anticholinergic drugs in medical and geriatric patients at admission (13.0% vs 17.5%, respectively; p = 0.08) and discharge (12.2% vs 16.5%, respectively; p = 0.10) were similar.

Conclusion

Inappropriate drug use as defined by the Beers criteria was common in both medical and geriatric inpatients. Compared with internists, geriatricians appear to be more aware of PIMs that should generally be avoided, but less aware of PIMs related to a specific diagnosis, and of the need to avoid anticholinergic drug use. However, the results of this study should be interpreted with caution because some of the drugs identified as potentially inappropriate may in fact be beneficial when the patient’s clinical condition is taken into consideration.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Table I
Fig. 1
Table II
Table III
Table IV

Similar content being viewed by others

References

  1. Hanlon JT, Schmader KE, Ruby CM, et al. Suboptimal prescribing in older inpatients and outpatients. J Am Geriatr Soc 2001 Feb; 49(2): 200–9

    Article  PubMed  CAS  Google Scholar 

  2. 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 Dec 8–22; 163(22): 2716–24

    Article  PubMed  Google Scholar 

  3. Passarelli MCG, Jacob-Filho W, Figueras A. Adverse drug reactions in an elderly hospitalised population. Drugs Aging 2005; 22(9): 767–77

    Article  PubMed  Google Scholar 

  4. Mannesse CK, Derkx FH, de Ridder MA, et al. Contribution of adverse drug reactions to hospital admission of older patients. Age Ageing 2000 Jan; 29(1): 35–9

    Article  PubMed  CAS  Google Scholar 

  5. Chang CM, Liu PY, Yang YH, et al. Use of the Beers criteria to predict adverse drug reactions among first-visit elderly outpatients. Pharmacotherapy 2005 Jun; 25(6): 831–8

    Article  PubMed  Google Scholar 

  6. Lau DT, Kasper JD, Potter DE, et al. Hospitalization and death associated with potentially inappropriate medication prescriptions among elderly nursing home residents. Arch Intern Med 2005 Jan 10; 165(1): 68–74

    Article  PubMed  Google Scholar 

  7. Tune LE. Anticholinergic effects of medication in elderly patients. J Clin Psychiatry 2001; 62Suppl. 21: 11–4

    PubMed  CAS  Google Scholar 

  8. Lechevallier-Michel N, Molimard M, Dartigues JF, et al. Drugs with anticholinergic properties and cognitive performance in the elderly: results from the PAQUID Study. Br J Clin Pharmacol 2005 Feb; 59(2): 143–51

    Article  PubMed  Google Scholar 

  9. Han L, McCusker J, Cole M, et al. Use of medications with anticholinergic effect predicts clinical severity of delirium symptoms in older medical inpatients. Arch Intern Med 2001; 161: 1099–105

    Article  PubMed  CAS  Google Scholar 

  10. Laroche ML, Charmes JP, Nouaille Y, et al. Impact of hospitalisation in an acute medical geriatric unit on potentially inappropriate medication use. Drugs Aging 2006; 23(1): 49–59

    Article  PubMed  Google Scholar 

  11. Saltvedt I, Spigset O, Ruths S, et al. Patterns of drug prescription in a geriatric evaluation and management unit as compared with the general medical wards: a randomised study. Eur J Clin Pharmacol 2005 Dec; 61(12): 921–8

    Article  PubMed  Google Scholar 

  12. World Health Organization. International statistical classification of diseases and related health problems [online]. Available from URL: http://www.who.int/classifications/icd/en/ [Accessed 2005 June 23]

  13. WHO Collaborating Centre for Drug Statistics Methodology. Anatomical Therapeutic Chemical (ATC) classification system [online]. Available from URL: http://www.whocc.no/atcddd/ [Accessed 2005 June 23]

  14. Fastbom J, Claesson CB, Cornelius C, et al. The use of medicines with anticholinergic effects in older people: a population study in an urban area of Sweden. J Am Geriatr Soc 1995 Oct; 43(10): 1135–40

    PubMed  CAS  Google Scholar 

  15. van der Hooft CS, Jong GW, Dieleman JP, et al. Inappropriate drug prescribing in older adults: the updated 2002 Beers criteria. A population-based cohort study. Br J Clin Pharmacol 2005 Aug; 60(2): 137–44

    Article  PubMed  Google Scholar 

  16. Viswanathan H, Bharmal M, Thomas J III, et al. Prevalence and correlates of potentially inappropriate prescribing among ambulatory older patients in the year 2001: Comparison of three explicit criteria. Clin Ther 2005 Jan; 27(1): 88–99

    Article  PubMed  Google Scholar 

  17. Fialova D, Topinkova E, Gambassi G, et al. Potentially inappropriate medication use among elderly home care patients in Europe. JAMA 2005 Mar 16; 293(11): 1348–58

    Article  PubMed  CAS  Google Scholar 

  18. Heininger-Rothbucher D, Daxecker M, Ulmer H, et al. Problematic drugs in elderly patients presenting to a European emergency room. Eur J Intern Med 2003 Oct; 14(6): 372–6

    Article  PubMed  Google Scholar 

  19. Chang CM, Liu PY, Yang YH, et al. Potentially inappropriate drug prescribing among first-visit elderly outpatients in Taiwan. Pharmacotherapy 2004 Jul; 24(7): 848–55

    Article  PubMed  Google Scholar 

  20. Stuffken R, van Hulten RP, Heerdink ER, et al. The impact of hospitalisation on the initiation and long-term use of benzodiazepines. Eur J Clin Pharmacol 2005 Jun; 61(4): 291–5

    Article  PubMed  Google Scholar 

  21. Allain H, Bentue-Ferrer D, Polard E, et al. Postural instability and consequent falls and hip fractures associated with use of hypnotics in the elderly: a comparative review. Drugs Aging 2005; 22(9): 749–65

    Article  PubMed  Google Scholar 

  22. Wang PS, Bohn RL, Glynn RJ, et al. Zolpidem use and hip fractures in older people. J Am Geriatr Soc 2001 Dec; 49(12): 1685–90

    Article  PubMed  CAS  Google Scholar 

  23. Ray WA, Thapa PB, Gideon P. Benzodiazepines and the risk of falls in nursing home residents. J Am Geriatr Soc 2000 Jun; 48(6): 682–5

    PubMed  CAS  Google Scholar 

  24. Wang PS, Bohn RL, Glynn RJ, et al. Hazardous benzodiazepine regimens in the elderly: effects of half-life, dosage, and duration on risk of hip fracture. Am J Psychiatry 2001 Jun; 158(6): 892–8

    Article  PubMed  CAS  Google Scholar 

  25. Passaro A, Volpato S, Romagnoni F, et al. Benzodiazepines with different half-life and falling in a hospitalized population: the GIFA study. Gruppo Italiano di Farmacovigilanza nell’Anziano. J Clin Epidemiol 2000 Dec; 53(12): 1222–9

    Article  PubMed  CAS  Google Scholar 

  26. Lenze EJ, Mulsant BH, Shear MK, et al. Anxiety symptoms in elderly patients with depression: what is the best approach to treatment? Drugs Aging 2002; 19(10): 753–60

    Article  PubMed  Google Scholar 

  27. Meagher DJ. Delirium: optimising management. BMJ 2001; 322: 144–9

    Article  PubMed  CAS  Google Scholar 

  28. Flacker JM, Marcantonio ER. Delirium in the elderly: optimal management. Drugs Aging 1998 Aug; 13(2): 119–30

    Article  PubMed  CAS  Google Scholar 

  29. Cole MG. Delirium in elderly patients. Am J Geriatr Psychiatry 2004 Jan–Feb; 12(1): 7–21

    PubMed  Google Scholar 

  30. Perri M III, Menon AM, Deshpande AD, et al. Adverse outcomes associated with inappropriate drug use in nursing homes. Ann Pharmacother 2005 Mar; 39(3): 405–11

    Article  PubMed  Google Scholar 

  31. Aparasu RR, Mort JR. Inappropriate prescribing for the elderly: Beers criteria-based review. Ann Pharmacother 2000 Mar; 34(3): 338–46

    Article  PubMed  CAS  Google Scholar 

  32. Fu AZ, Liu GG, Christensen DB. Inappropriate medication use and health outcomes in the elderly. J Am Geriatr Soc 2004 Nov; 52(11): 1934–9

    Article  PubMed  Google Scholar 

  33. Fick DM, Waller JL, Maclean JR, et al. Potentially inappropriate medication use in a Medicare managed care population: association with higher costs and utilization. J Manag Care Pharm 2001 Nov; 7(5): 407–13

    Google Scholar 

  34. Hanlon JT, Fillenbaum GG, Kuchibhatla M, et al. Impact of inappropriate drug use on mortality and functional status in representative community dwelling elders. Med Care 2002 Feb; 40(2): 166–76

    Article  PubMed  Google Scholar 

  35. Aparasu RR, Mort JR. Prevalence, correlates, and associated outcomes of potentially inappropriate psychotropic use in the community-dwelling elderly. Am J Geriatr Pharmacother 2004 Jun; 2(2): 102–11

    Article  PubMed  Google Scholar 

  36. Fillenbaum GG, Hanlon JT, Landerman LR, et al. Impact of inappropriate drug use on health services utilization among representative older community-dwelling residents. Am J Geriatr Pharmacother 2004 Jun; 2(2): 92–101

    Article  PubMed  Google Scholar 

  37. Chin MH, Wang LC, Jin L, et al. Appropriateness of medication selection for older persons in an urban academic emergency department. Acad Emerg Med 1999 Dec; 6(12): 1232–42

    Article  PubMed  CAS  Google Scholar 

  38. Onder G, Landi F, Liperoti R, et al. Impact of inappropriate drug use among hospitalized older adults. Eur J Clin Pharmacol 2005 Jul; 61(5-6): 453–9

    Article  PubMed  Google Scholar 

  39. Crownover BK, Unwin BK. Implementation of the Beers criteria: sticks and stones — or throw me a bone. J Manag Care Pharm 2005 Jun; 11(5): 416–7

    PubMed  Google Scholar 

  40. Swagerty D, Brickley R. 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 2005 Jan–Feb; 6(1): 80–6

    Article  PubMed  Google Scholar 

  41. Levine MN, Raskob G, Beyth RJ, et al. Hemorrhagic complications of anticoagulant treatment: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004 Sep; 126 (3 Suppl.): 287S–310S

    Article  PubMed  CAS  Google Scholar 

  42. Buresly K, Eisenberg MJ, Zhang X, et al. Bleeding complications associated with combinations of aspirin, thienopyridine derivatives, and warfarin in elderly patients following acute myocardial infarction. Arch Intern Med 2005 Apr 11; 165(7): 784–9

    Article  PubMed  CAS  Google Scholar 

  43. Macie C, Forbes L, Foster GA, et al. Dosing practices and risk factors for bleeding in patients receiving enoxaparin for the treatment of an acute coronary syndrome. Chest 2004 May; 125(5): 1616–21

    Article  PubMed  Google Scholar 

  44. Battistella M, Mamdami MM, Juurlink DN, et al. Risk of upper gastrointestinal hemorrhage in warfarin users treated with non-selective NSAIDs or COX-2 inhibitors. Arch Intern Med 2005 Jan 24; 165(2): 189–92

    Article  PubMed  CAS  Google Scholar 

  45. Torn M, Bollen WL, van der Meer FJ, et al. Risks of oral anticoagulant therapy with increasing age. Arch Intern Med 2005 Jul 11; 165(13): 1527–32

    Article  PubMed  CAS  Google Scholar 

  46. Fang MC, Chang Y, Hylek EM, et al. Advanced age, anticoagulation intensity, and risk for intracranial hemorrhage among patients taking warfarin for atrial fibrillation. Ann Intern Med 2004 Nov 16; 141(10): 745–52

    PubMed  Google Scholar 

  47. Iorio A, Guercini F, Pini M. Low-molecular-weight heparin for the long-term treatment of symptomatic venous thromboembolism: meta-analysis of the randomized comparisons with oral anticoagulants. J Thromb Haemost 2003 Sep; 1(9): 1906–13

    Article  PubMed  CAS  Google Scholar 

  48. Campbell NR, Hull RD, Brant R, et al. Aging and heparin-related bleeding. Arch Intern Med 1996 Apr 22; 156(8): 857–60

    Article  PubMed  CAS  Google Scholar 

  49. Huisman MV, Bounameaux H. Treating patients with venous thromboembolism: initial strategies and long-term secondary prevention. Semin Vasc Med 2005 Aug; 5(3): 276–84

    Article  PubMed  Google Scholar 

  50. Conde-Martel A, Perez-Correa S, Hemmersbach-Miller M, et al. Spontaneous retroperitoneal hematomas in elderly patients treated with low-molecular-weight heparins. J Am Geriatr Soc 2005 Mar; 53(3): 548–9

    Article  PubMed  Google Scholar 

  51. Vadiei K, Troy S, Korth-Bradley J, et al. Population pharmacokinetics of intravenous amiodarone and comparison with two-stage pharmacokinetic analysis. J Clin Pharmacol 1997 Jul; 37(7): 610–7

    PubMed  CAS  Google Scholar 

  52. Goldschlager N, Epstein AE, Naccarelli G, et al. Practical guidelines for clinicians who treat patients with amiodarone: Practice Guidelines Subcommittee, North American Society of Pacing and Electrophysiology. Arch Intern Med 2000 Jun 26; 160(12): 1741–8

    Article  PubMed  CAS  Google Scholar 

  53. Hohnloser SH, Klingenheben T, Singh BN. Amiodarone-associated proarrhythmic effects: a review with special reference to torsade de pointes tachycardia. Ann Intern Med 1994 Oct 1; 121(7): 529–35

    PubMed  CAS  Google Scholar 

  54. Cairns JA, Connolly SJ, Roberts R, et al. Randomised trial of outcome after myocardial infarction in patients with frequent or repetitive ventricular premature depolarisations: CAMIAT — Canadian Amiodarone Myocardial Infarction Arrhythmia Trial Investigators. Lancet 1997 Mar 8; 349(9053): 675–82

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

The authors have no conflicts of interest that are directly relevant to the content of this study.

Stephan Krähenbühl is supported by a grant from the Swiss National Science Foundation (310’000-112483/1). No other sources of funding were used to assist in the preparation of this study.

Author information

Authors and Affiliations

  1. Clinical Pharmacology and Toxicology, University Hospital of Basel, Hebelstrasse 2, Basel, CH-4031, Switzerland

    Sabin S. Egger MSc, Andrea Bachmann, Nathalie Hubmann, Raymond G. Schlienger & Stephan Krähenbühl

Authors
  1. Sabin S. Egger MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andrea Bachmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nathalie Hubmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Raymond G. Schlienger
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Stephan Krähenbühl
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sabin S. Egger MSc.

Appendix

Appendix

Drugs listed in the Beers criteria published in 2003,[2] but not marketed in Switzerland are: carisoprodol, chlorpheniramine, chlorzoxazone, cyclobenzaprine, cyproheptadine, desiccated thyroid, dicyclomine, disopyramide, ethacrynic acid, guanadrel, guanethidine, halazepam, hyoscyamine, isoxsurpine, mesoridazine, metaxalone, methamphetamine, methocarbamol, methyltestosterone, orphenadrine, oxaprozin, pemolin, perphenazine-amitriptyline, prazosin, propantheline, propoxyphene, pseudoephedrine, quazepam, tacrine, thiothixene, ticlopidine, trimethobenzamide and tripelennamine.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Egger, S.S., Bachmann, A., Hubmann, N. et al. Prevalence of Potentially Inappropriate Medication Use in Elderly Patients. Drugs Aging 23, 823–837 (2006). https://doi.org/10.2165/00002512-200623100-00005

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00002512-200623100-00005

Keywords

Search

Navigation