Inappropriate Medication Use in Community-Residing Older Persons

doi:10.1001/archinte.1994.00420190095011

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Vol. 154 No. 19, 10 October 1994

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Inappropriate Medication Use in Community-Residing Older Persons

Andreas E. Stuck, MD; Mark H. Beers, MD; Andrea Steiner, PhD; Harriet U. Aronow, PhD; Laurence Z. Rubenstein, MD; John C. Beck, MD

Arch Intern Med. 1994;154(19):2195-2200.

Abstract

Background
Elderly patients taking inappropriate drugs are at increasedrisk for adverse outcomes. We investigated the prevalence ofinappropriate drug use and its predisposing factors in community-residingolder persons.

Methods
We conducted in-home interviews with 414 subjects aged 75 yearsand older living in the community of Santa Monica, Calif. Inappropriatemedication use was evaluated using explicit criteria developedthrough a modified Delphi consensus process. These criteriaidentified drugs that should generally be avoided in elderlycommunity-residing subjects regardless of dosage, duration oftherapy, or clinical circumstances.

Results
Based on these conservative criteria, 14.0% of the subjectswere using at least one inappropriate drug. The most commonexamples were long-acting benzodiazepines, persantine, amitriptyline,and chlorpropamide. Subjects using three or more prescriptiondrugs, compared with one or two, were more likely to be takingan inappropriate medication (odds ratio, 3.9; 95% confidenceinterval, 1.9 to 7.9). Furthermore, subjects with depressivesymptoms had a higher risk of receiving inappropriate medicationsthan nondepressive subjects (odds ratio, 2.2; 95% confidenceinterval, 1.1 to 4.1).

Conclusions
Inappropriate drug use is a common problem in community-residingolder persons. The risk of inappropriate drug use is increasedin patients taking multiple medications and in patients withdepressive symptoms.

(Arch Intern Med. 1994;154:2195-2200)

Author Affiliations

From the Department of Geriatrics and Rehabilitation, Zieglerspital, Bern, Switzerland (Dr Stuck); Merck and Co Inc, West Point, Pa (Dr Beers); Centre for Analysis of Social Policy, University of Bath, England (Dr Steiner); and Multicampus Program of Geriatric Medicine and Gerontology, Department of Medicine, University of California—Los Angeles, School of Medicine (Drs Aronow, Rubenstein, and Beck).

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