Defining inappropriate practices in prescribing for elderly people: a national consensus panel

Area of Science:

• Geriatric Pharmacology
• Clinical Pharmacy Practice
• Medication Safety in Elderly Populations

Background:

• Polypharmacy and altered pharmacokinetics in the elderly increase risks of adverse drug events.
• Inappropriate prescribing practices contribute significantly to morbidity and mortality in older adults.
• A need exists for evidence-based guidelines to optimize medication use in geriatric patients.

Purpose of the Study:

• To establish a consensus-based list of inappropriate prescribing practices specific to elderly individuals.
• To identify drug prescribing practices that pose a substantial risk of serious adverse effects in the elderly.
• To provide recommendations for safer alternative therapies for identified inappropriate practices.

Main Methods:

• A mail survey was conducted with a 32-member national panel of specialists in Canada.
• Participants included clinical pharmacologists, geriatricians, family practitioners, and pharmacists.
• Consensus was reached on practices increasing risk of adverse effects, clinical importance, and availability of safer alternatives.

Main Results:

• A list of 71 inappropriate prescribing practices for elderly people was developed.
• Practices were categorized into contraindications, drug-disease interactions, and drug-drug interactions.
• 39 practices received a mean clinical significance rating above 3, with alternative therapies recommended for each.

Conclusions:

• A valid and relevant list of inappropriate prescribing practices for the elderly has been established.
• The developed list serves as a foundation for practice-based intervention studies.
• The consensus process demonstrated strong agreement among specialists regarding risk and alternatives.