Inappropriate drug prescribing in home-dwelling, elderly patients: a population-based survey

In 1997, a US expert panel developed explicit criteria on potentially inappropriate drugs for the general elderly population.

To investigate the proportion of inappropriate medications among home-dwelling, elderly patients in Helsinki, Finland, between November 1, 1998, and March 31, 1999.

A cross-sectional mail survey was sent to a random sample of 3921 elderly urban residents aged 75, 80, 85, 90, and 95 years. Of these, 3219 were home dwellers.

Prevalence of potentially inappropriate drugs and prevalence of drugs considered inappropriate related to 15 common medical conditions according to recommendations given by the expert panel in 1997.

The response rate was 78%. Of the respondents, 12.5%, 1.3%, and 0.2% were taking at least 1, 2, or 3 inappropriate drugs, respectively. The most prevalent inappropriate drugs were dipyridamole (3.6%), long-acting benzodiazepines (2.6%), amitriptyline hydrochloride (1.6%), ergot mesyloids (1.6%), muscle relaxants (1.2%), and meprobamate (1.1%). Use of medications considered inappropriate with certain medical conditions was higher: 27.2% of patients with chronic obstructive pulmonary disease were taking beta-blockers and 19.3% used sedatives. Of diabetic individuals taking oral hypoglycemics or insulin, 32.5% were taking a concomitant beta-blocker. Of those with a peripheral vascular disease, 37.9% were taking beta-blockers. However, two thirds of all these patient groups had concomitant coronary heart disease.

Compared with previous surveys, the use of inappropriate medications in our home-dwelling, elderly population is conspicuously low. In contrast, use of certain drugs considered inappropriate with different medical conditions was relatively high. However, the inappropriateness of the latter treatments may be questioned in individual patients.