Rate of Inappropriate Prescription for Elderly Remains High

Despite attention to improving the quality of prescription, 1 in 5 prescriptions to elderly patients in primary care settings is inappropriate.

Approximately 1 in 5 prescriptions for elderly patients in a primary care setting is inappropriate, according to the results of a review of studies published online on August 22, 2012, in PLoS ONE. The review looked at 19 previous studies conducted in 11 different countries, with 7 conducted in the United States.

Inappropriate medication prescription (IMP) is defined as prescribing the wrong dose of a medication or prescribing a medication that introduces a significant risk of an adverse drug event when there is an alternative medication available that is at least equally effective. IMP can be classified as overprescribing, underprescribing, or misprescribing. Since many elderly patients have chronic diseases and comorbidities that require multiple medications, they face an elevated risk of IMP and adverse drug events.

The results of the review showed that the median rate of IMP for elderly patients in primary care settings was 20.5%, although the rates varied widely, from 2.9% to 38.5%. (In the 7 studies conducted in the United States, the median rate of IMP was 19.6%.) The medications with the highest median rates of IMP were the NSAID propoxyphene (4.52%), the antihypertensive doxazosin (3.96%), the antihistamine diphenhydramine (3.30%), and the antidepressant amitriptyline (3.20%). Of these, diphenhydramine and amitriptyline have high-risk adverse events and propoxyphene and doxazosin have low-risk adverse events.

The researchers note that IMP rates for the elderly in primary care settings remain high even though a great deal of attention has been devoted to improving the quality of prescription. One way to address this problem, they note, is to employ clinical decision support systems, which provide alerts during the prescription process based on guidelines such as the Beers criteria.