Inappropriate drug prescribing in older adults: the updated 2002 Beers criteria – a population‐based cohort study

Abstract

Background In 1997, Beers and colleagues developed explicit criteria for potentially inappropriate drug prescribing in ambulatory older adults aged 65 years and over. Several studies have been performed to estimate the prevalence of inappropriate drug prescribing based on these criteria. In 2002, the criteria were updated. Aims To examine the extent and trend of inappropriate drug prescribing to ambulatory older adults in the Netherlands between 1997 and 2001, according to the 1997 and the updated Beers criteria. Methods Data were retrieved from the Integrated Primary Care Information (IPCI) project, a general practice research database with data from computer‐based patient records of a group of 150 general practitioners in the Netherlands. All subjects aged 65 and over were included. Prescriptions were classified as inappropriate if they fulfilled the Beers criteria of prescriptions that generally should be avoided in older adults because of a high risk of adverse effects, while also considering dose and comorbidity. Results Between 1997 and 2001, the 1‐year risk of receiving at least one inappropriate drug prescription for older adults ranged between 16.8% (95% CI: 16.3–17.3%) and 18.5% (18.3–18.7%) according to the 1997 criteria and between 19.1% (18.6–19.6%) and 20.0% (19.5–20.5%) according to the updated Beers criteria. According to the updated criteria, the most frequently prescribed inappropriate drugs were nitrofurantoin, long‐acting benzodiazepines, amitriptyline, promethazine and cimetidine. Temazepam and zolpidem were mostly prescribed in supratherapeutic dose. Conventional NSAIDs in persons with a history of gastric/duodenal ulcer were the most frequently prescribed contra‐indicated drugs. Conclusions Prescribing potentially inappropriate prescriptions to ambulatory older people in the Netherlands is substantial. Compared with other studies using the 1997 Beers criteria, inappropriate prescribing to the elderly is lower than in the USA but similar to Finland. Despite a restrictive medication policy and a growing attention for medication surveillance in Europe, inappropriate drug prescribing is still a substantial problem.

Potentially inappropriate prescribing in an Irish elderly population in primary care

“…Beers' criteria [21], suggests that STOPP may be a more relevant potential IP detection tool in primary care in Ireland than Beers' criteria, as many of Beers' criteria are redundant in the Irish setting [30]. Similarly, in a recent Dutch study it was noted that only 24 of the 78 drugs in Beers' list were available in the Netherlands [12]. Conversely, a number of the medicines in the most recent iteration of Beers' independent of diagnosis criteria are not contraindicated in older people according to the latest edition of the British National Formulary [31], e.g.…”

“…Inappropriate prescription of long-acting benzodiazepines in older patients has been highlighted repeatedly in the literature over the last 25 years, in particular given the link with falls and fracture risk and the difficulties with successful withdrawal [35][36][37]. Despite this, long-acting benzodiazepines continue to be initiated and repeatedly prescribed for older patients in primary and secondary care in Ireland and other countries [10,[12][13][14]. These realities suggest that long-acting benzodiazepines should not be initiated in older patients, given their high propensity for psychological and physical dependency.…”

“…Beers' criteria were originally formulated in 1991 [7], updated in 1997 [8] and recently revised in 2003 [4]. Using Beers' criteria in primary care, IP rates of 9.8-38.5% have been reported in various European countries [9][10][11][12][13][14], while IP rates of 21.3-28.8% have been reported in the USA [15][16][17]. Beers' criteria have a number of serious deficiencies in relation to European prescribing patterns.…”

Potentially inappropriate medications among elderly Brazilian outpatients

“…32 In other studies that used the 2003 version of the Beers criteria, the PIMs that were most prescribed were long-action benzodiazepines, propoxyphene, amitriptyline and antihistamines. 10,12,14,27,33 Estrogen, muscle relaxants, ticlopidine, chlordiazepoxide and anti-inflammatory agents have also been cited. 12,27,33 In Brazil, Carvalho observed that anti-inflammatory agents, methyldopa, digoxin and benzodiazepines with long half-life were the PIMs most used by elderly people in the city of São Paulo.…”

Uso de anti-inflamatórios e analgésicos por uma população de idosos atendida na Estratégia Saúde da Família

“…14,15 Anti-inflammatory drugs should generally be avoided in elderly patients, especially those with peptic ulcers, chronic liver or heart disease or hypertension, and individuals using drugs with antiplatelet action, such as aspirin, corticosteroids or selective serotonin reuptake inhibitors. 16,17 Many studies have indicated that the prevalence of prescribing drugs that interact with each other for patients using anti-inflammatories is very high, and of considerable concern. 18 Older people are major users of health services and subsequently of medication, including anti-inflammatory and analgesic drugs.…”