Appropriate proton pump inhibitors use in elderly outpatients according to recommendations

Proton pump inhibitors (PPI) are widely prescribed, particularly in elderly patients, and their side effects are underestimated. Recommendations of the french health authorities, some specific to the elderly, specify their indications. The main objective of this descriptive and prospective study was to assess in elderly patients the adequacy of PPI prescriptions to these recommendations and to the marketing authorization.

Analysis of all patients hospitalized in an acute geriatric unit over a period of 2 years for which the drug prescription on admission included a PPI.

For the 125 patients included (mean age 84 years), the PPI treatment period exceeded one year in 68% of cases and 49.6% of PPI prescriptions were not consistent with the recommendations; not recommended indications are mainly prevention of gastroduodenal lesions in case of antiplatelet, VKA or corticosteroid treatment (24%), anemia (12%) or epigastric pain (8.5%) without prior endoscopic exploration. Only 50.4% of patients treated with PPI had an upper gastro-intestinal endoscopy, which should be systematically performed in patients over 65 years according to the recommendations.

Our study confirms the low appropriateness of PPI prescriptions, particularly in elderly patients. This can be explained by controversial issues or by difficulties in adapting these recommendations in geriatric practice.