Inappropriate prescriptions for the elderly prevalent in primary care

One in five prescriptions in primary care for the elderly is inappropriate, say the authors of a systematic review.

The review, which included data from 11 countries, showed that both high- and low-risk medications were subject to inappropriate prescriptions.

"In spite of increasing attention to the quality of medication prescription among elderly persons presenting to the primary care setting, there are still high overall rates of inappropriate medication prescription [IMP]," say Dedan Opondo (University of Amsterdam, the Netherlands) and colleagues.

The systematic review included 19 English-language studies from the USA, Europe, Taiwan, Iran, and India, which analyzed rates of IMPs in patients aged over 65 years. They used the Beers criteria, which lists medications appropriate for elderly patients, and other tools to assess rates of IMP.

The authors found that the median rate of IMPs was 20.0%. However, it varied highly between studies, ranging from 2.9% to 38.5%.

The four most common IMPs were the pain reliever propoxyphene (4.5%), the antihypertensive doxazosin (4.0%), the antihistamine diphenhydramine (3.3%), and the antidepressant amitriptyline (3.2%).

Amitriptyline and diphenhydramine were also the most commonly inappropriately prescribed high-risk medications. Additionally, the authors found that some high-risk medications, such as diazepam and nifedipine, had a high prevalence of inappropriate prescription compared with other medications in their therapeutic classes.

They say that their results show a need for interventions in primary care to improve the quality of prescriptions for the elderly: "Prescription of high-risk medication exposes the elderly to frequent and severe adverse drug events. Alternative low-risk medications should be prescribed when available."

The authors say high-risk classes of drug would be especially suitable targets for improving the quality of prescriptions, such as through the use of clinical decision support systems.

They add that future studies are needed to explore factors that predispose elderly patients to IMPs as well as to investigate the choices of medication among physicians.

Writing in PLoS One, they conclude: "Focused and systematic interventions are needed to improve the quality of medication prescription in this patient group."

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