Inappropriate medication use among the elderly: a systematic review of administrative databases

Abstract

BackgroundInappropriate medication use (IMU) by elderly people is a public health problem associated with adverse effects on health. There are a number of methods for identifying IMU, some involving clinical judgment and others, consensually generated lists of drugs to be avoided. This review aims to describe studies that used information from insurance company and social security administrative databases to assess IMU among community-dwelling elderly and to present the risk factors most often associated with IMU.MethodsThe paper search was conducted in Medline and Embase, using descriptors combined with free terms in the title or abstract. The limits applied were: publication date from January 1990 to June 2010, species (human) and publication type (excluding editorials, letters and reviews). Excluded were: case studies; studies in hospitals, nursing homes, or hospital emergency departments; studies of specific drugs or groups of drugs; studies exclusively of subgroups of ill, frail elderly or rural populations. Additional studies were identified from reference lists. Data were selected and extracted after independent reading by two of the authors, with disagreements resolved by a third author. The primary outcome assessed was prevalence of IMU, defined as the proportion of elderly who received at least one inappropriate medication.ResultsOf the 628 studies, 19 met the inclusion criteria, 78.9% of them conducted in the USA. All papers included used explicit criteria of inappropriateness, most commonly Beers criteria (73.7%) in their three versions (1991, 1997 and 2002). Other methods used included Zhan, which is derived from on Beers criteria and was applied in 21% of the papers selected. The study found that prevalence of IMU ranged from 11.5% to 62.5%. Only 68.4% of the studies included examined inappropriate use-related factors, the most important being female sex, advanced age and larger number of drugs.ConclusionsThe results show that the prevalence of IMU among community-dwelling elderly is high and depends partly on the method used to evaluate improper use. Besides the diversity of methods, other factors, such as patient sex, age and number of drugs used concurrently, appear to have influenced the estimates of IMU.

Potentially inappropriate prescribing in elderly population: A study in medicine out-patient department

“…15,16 In our study, we found the average number of drugs prescribed was 5.56 per prescription. Similar studies carried out among geriatric patients in another place of Nepal, 17 Turkey, 18 USA, 13 India, 6 Brazil, 19 The less number of drugs prescribed in our study compared to studies conducted in other countries might be due to a functional health insurance policy for the elderly in those countries which might have provided easier access to medications. The most common form of morbidities found in this study was from cardiovascular system (47.0%) with hypertension.…”

Interações medicamentosas potenciais entre idosos em uso dos anti-hipertensivos da Relação Nacional de Medicamentos Essenciais do Ministério da Saúde do Brasil

“…Há ferramentas de orientação em alguns países, entretanto é necessário o desenvolvimento de listas nacionais, construídas com base em fármacos comercializados em cada país 20 .…”

Prevalência e fatores associados ao diabetes em idosos no município de Viçosa, Minas Gerais

“…In this study, it was observed that a higher prevalence occurred in the consumption of five or more medication drugs among the diabetic people. Here, it is important to reflect about the conditions under which polypharmacy occurs, considering that several studies have related this phenomenon to the inappropriate use of medication among elderly people 38,39 , which can be an aggravating factor to the adequate DM control in this population.…”