Study identifies 329 instances of potentially inappropriate prescribing in Irish older patients

Research published in the journal Age and Ageing, which studied nursing homes in the Munster region of Ireland, has found that a significant proportion of older patients have either been prescribed a potentially inappropriate medicine or they are not prescribed a medicine that would normally be beneficial.

The authors identified 329 instances of potentially inappropriate prescribing (PIP) in 187 (59.8%) patients. Of these patients, 98 (31.3%) were prescribed one medicine that was potentially inappropriate, 47 (15.0%) were prescribed two, and 32 (10.2%) were prescribed three. Medicine for the central nervous system (CNS) accounted for the highest proportion of PIP identified, followed by high proportions of medication for the gastrointestinal system, the cardiovascular system, and for patients who frequently fall. In this group, benzodiazepines accounted for the highest proportion of potentially inappropriate medicines prescribed. 

The research also identified 199 potential prescribing omissions (PPO) in 132 patients. The cardiovascular system accounted for most of the PPOs identified and of these, the most common was the omission of a low-dose aspirin.

Contributing author Stephen Byrne, from University College Cork, comments that "the figures found in this study are higher when compared with figures reported in studies conducted in primary and in secondary care.  This may reflect the higher levels of multiple chronic conditions found in older patients residing in long term care facilities, which often results in more medicines being prescribed."

"We found that medicines for the blood and blood forming organs accounted for almost ten per cent (9.2%) of the medicines prescribed in this study. We feel that this is an underestimation of the true requirements for these medicines, as anti-platelet agents and anticoagulants accounted for a third of the omissions identified. "

"Our study shows that there is a need to consider measures of ensuring patients are not at risk of medication related adverse events. The screening tools STOPP and START could form the basis of a pharmaceutical care review for these patients. The feasibility of establishing such a service needs to be further explored."