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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.
JAMA
|July 27, 1994
Summary
Nearly a quarter of older Americans receive inappropriate medications, increasing risks. Broader initiatives are needed to improve prescribing for seniors.
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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