A new study from RCSI (Royal College of Surgeons in Ireland) and Trinity College Dublin, which examined the prevalence of potentially inappropriate prescribing (PIP) and prescribing omissions in older Irish adults, has found that 14% of people over the age of 65 has been prescribed at least one inappropriate form of medication in their lives and 30% have not been prescribed clinically indicated medications, at least once in their lives. The research was carried out by RCSI’s Department of General Practice, the Health Research Board (HRB) Centre for Primary Care Research and Trinity College Dublin, using data from The Irish Longitudinal Study on Ageing (TILDA), and was recently published in the European Journal of Clinical Pharmacology.
Potentially inappropriate prescribing in older adults is a term used for medications that should be generally avoided in this age group and where doses or frequencies of administration that should not be exceeded.
Speaking on the findings, lead researcher Dr Rose Galvin, RCSI Department of General Practice and Programme Leader at the HRB Centre for Primary Care Research, said, ‘These figures of potentially inappropriate prescribing and omissions in patient’s medication are worrying. We found that the most frequently inappropriate prescribed drugs were non-steroidal, anti-inflammatory medications which were dispensed to patients with moderate-severe hypertension; and aspirin dispensed to those with no history of coronary, cerebral, or peripheral vascular symptoms.
We also found that the most common prescribing omission were antidepressant drugs in the presence of patients with moderate to severe depressive symptoms that could last at least three months.’
The research revealed a direct correlation between both PIP and prescribing omission with polypharmacy, or the use of multiple medications by a single patient. The researchers concluded that the application of a screening tool to assist prescribing decisions can reduce unnecessary medication, related adverse events, healthcare utilisation and cost.
Dr Galvin went on to say, ‘It is clear that doctors and pharmacists who dispense these medications to patients must be extra-vigilant when dispensing and prescribing medicines to their patients. Better efforts should be directed to place particular focus on appropriateness of medication issued to patients both with respect to under and over-prescribing.’
Dr Graham Love, Chief Executive of the Health Research Board commented, ‘This is a practical demonstration of the contribution that research can make to improving patient care. Hand in hand with improved patient care, research can also contribute to lower costs both through appropriate prescribing in the first instance, and subsequently not having to deal with knock on or side effects of the inappropriate prescribing’.
RCSI is a not-for-profit health sciences institute which focuses on education and research to drive positive change in all areas of human health worldwide. RCSI is headquartered in Dublin and is a recognised College of the National University of Ireland. In 2010, RCSI was granted independent degree awarding status by the State, which enables the College to award degrees alongside its traditional powers to award licentiates.
- Journal Reference: Eur J Clin Pharmacol. 2014 May; 70(5):599-606. doi: 10.1007/s00228-014-1651-8. Epub 2014 Feb 4 (http://www.ncbi.nlm.nih.gov/pubmed/24493365)
- A total of 3,507 people in Ireland aged 65 years or more, were identified from the TILDA (The Irish LongituDinal Study on Ageing) database. TILDA is a nationally representative cohort study of people aged 50 years and over and resident in Ireland, charting their health, social and economic circumstances over a 10 year period.