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Questionable prescribing for elderly patients in Quebec

R M Tamblyn1, P J McLeod, M Abrahamowicz

  • 1Department of Medicine, McGill University, Montreal, Que.

CMAJ : Canadian Medical Association Journal = Journal De L'Association Medicale Canadienne
|June 1, 1994
PubMed
Summary
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High-risk prescribing is common in elderly individuals, with over half experiencing it. Questionable prescribing, particularly with psychotropic drugs, poses a significant, avoidable risk for drug-related illness in this population.

Area of Science:

  • Geriatric pharmacology
  • Public health
  • Medication safety

Background:

  • High-risk prescribing is a concern in elderly populations.
  • Cardiovascular drugs, psychotropic drugs, and NSAIDs are commonly implicated in drug-related illnesses.
  • Understanding prescribing patterns is crucial for patient safety.

Purpose of the Study:

  • To estimate the prevalence of questionable and rational high-risk prescribing in elderly individuals.
  • Focus on cardiovascular drugs, psychotropic drugs, and NSAIDs.
  • Identify risk factors associated with high-risk prescribing.

Main Methods:

  • Retrospective prevalence study utilizing prescription and billing records from Quebec's Régie de l'assurance-maladie.
  • Sample included 63,268 elderly residents not in health care institutions.

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  • Examined drug combinations, treatment duration, and contraindications in the elderly.

    • Main Results:

    • Over half (52.6%) of elderly patients experienced high-risk prescribing; 45.6% had questionable prescribing.
    • Psychotropic drugs showed the highest prevalence of high-risk and questionable prescribing.
    • Long-term benzodiazepine use (over 30 days) affected 30.8% of patients.

    Conclusions:

    • Questionable high-risk prescribing, especially for psychotropic drugs, is substantial in the elderly population.
    • This represents a significant and potentially avoidable risk factor for drug-related illness.
    • Interventions targeting high-risk prescribing may improve health outcomes for older adults.