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Elderly patients often receive inappropriate medications

Patient Safety Monitor Alert, August 13, 2004

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Physicians commonly prescribe inappropriate medications for elderly patients, according to new research, which underscores the importance of carefully monitoring patients' medications.

Lesley H. Curtis, PhD, of Duke University Medical Center, Durham, NC, and colleagues investigated the extent of potentially inappropriate medication prescribing for elderly patients not in the hospital. They defined "inappropriate" medications using the Beers List, a national guideline and reference guide for pharmacists and physicians to improve the use of medication in the elderly.

Researchers examined the outpatient claims database of a large national pharmaceutical benefit company that included 765,423 patients aged 65 or older who filled one or more prescription drug claims during 1999. They found that 162,370 patients (21%) filled a prescription for a drug deemed to be potentially inappropriate for their age group.

In addition:

>>Amitriptyline and doxepin (drugs used for treatment of depression) accounted for 23% of claims for Beers list drugs. Most of those claims (51%) were for drugs with potentially harmful effects

>> More than 15% of patients filled prescriptions for two drugs of concern

>> 4% percent filled prescriptions for three or more drugs of concern within the same year

"The common use of potentially inappropriate drugs should serve as a reminder to monitor their use closely," the authors conclude. "Pharmaceutical claims databases can be important tools for accomplishing this task, though clinical and laboratory data are needed to improve the sensitivity and specificity of patient-specific alerts."

The results appear in the August 9/23 issue of The Archives of Internal Medicine. An editorial that accompanies the study calls for pharmacists to become more involved in the medication management process and for organizations to use computer programs that identify and flag all inappropriate prescriptions.

"One way to begin is to include pharmacists in the process of prescription writing in a more meaningful way," writes Knight Steel, MD, of Hackensack University Medical Center, NJ. "Since they usually have information about patients' age, pharmacists could be required to question the use of certain drugs or dosages in the elderly."

Organizations have to pay closer attention to their patients' medications beginning January 1, when the JCAHO's 2005 National Patient Safety Goals go into effect.

One of the goals requires organizations to reconcile medications across the continuum of care "accurately and completely," by developing a process for obtaining a complete list of each patient's current medications.

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