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Elderly patients receive "inappropriate" medications during ambulatory visits

Patient Safety Monitor Alert, February 11, 2004

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About 8% of elderly patients receive "inappropriate" medications during outpatient visits, according to an article in the February 9 issue of The Archives of Internal Medicine (Vol. 164, No. 3). Pain relievers and central nervous system drugs made up most of the inappropriate prescriptions.

Margie Rauch Goulding, PhD, of the U.S. Centers for Disease Control and Prevention, in Hyattsville, MD, examined trends in the use of potentially inappropriate drug prescribing during ambulatory care visits for older persons in 1995 and 2000. She found that the odds of inappropriate prescriptions were higher for patients with multiple prescriptions, and were double for women.

During visits in 1995 and 2000, Goulding found that at least one drug considered inappropriate by experts was prescribed during nearly 8% of ambulatory care visits, and that at least one drug classified as "never or rarely appropriate" was prescribed nearly 4% of the time.

"Potentially inappropriate prescribing at ambulatory care visits for elderly patients, particularly women, remains a substantial problem," Goulding writes. "Interventions could target more appropriate drug selection by physicians when prescribing pain relievers, anti-anxiety agents, sedatives, and antidepressants to elderly patients. Such behavior could eliminate a large portion of inappropriate prescribing for elderly patients and reduce its higher risk for women."

Inappropriate medication use in patients 65 or older has been linked to adverse drug reactions, poor physical functioning, and excessive use of health care.

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