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Inappropriate drug prescribing for the community-dwelling elderly

S M Willcox¹, D U Himmelstein, S Woolhandler

¹Victorian Health Department, Melbourne, Australia.

|July 27, 1994

Summary

Nearly a quarter of older Americans receive inappropriate medications, increasing risks. Broader initiatives are needed to improve prescribing for seniors.

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Area of Science:

Geriatrics
Pharmacology
Public Health

Background:

Inappropriate prescribing of medications is a significant concern for older adults.
Community-dwelling elderly individuals are particularly vulnerable to adverse drug events.
Existing strategies have primarily focused on institutionalized elderly populations.

Purpose of the Study:

To determine the prevalence of inappropriate drug prescribing among community-dwelling Americans aged 65 and older.
To identify specific drugs frequently prescribed inappropriately to this demographic.

Main Methods:

A cross-sectional survey using data from the 1987 National Medical Expenditure Survey.
Analysis included 6171 older adults, with weighting to ensure national representativeness.
Utilized explicit criteria developed by geriatrics experts to identify 20 potentially inappropriate drugs.

Main Results:

23.5% of older adults (6.64 million) received at least one of the 20 potentially inappropriate drugs.
Commonly prescribed inappropriate drugs included dipyridamole, propoxyphene, and amitriptyline.
Including controversial cardiovascular drugs raised the incidence to 32% (9.04 million).

Conclusions:

Physicians prescribe potentially inappropriate medications to a substantial portion of community-dwelling elderly.
This practice places older adults at risk for adverse effects like cognitive impairment and sedation.
There is a need for broader educational and regulatory strategies beyond nursing home-focused initiatives.

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