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Inappropriate Drug Prescribing in Home-Dwelling, Elderly Patients
A Population-Based Survey
Kaisu H. Pitkala, MD, PhD;
Timo E. Strandberg, MD, PhD;
Reijo S. Tilvis, MD, PhD
Arch Intern Med. 2002;162:1707-1712.
Background In 1997, a US expert panel developed explicit criteria on potentially
inappropriate drugs for the general elderly population.
Objective To investigate the proportion of inappropriate medications among home-dwelling,
elderly patients in Helsinki, Finland, between November 1, 1998, and March
31, 1999.
Methods A cross-sectional mail survey was sent to a random sample of 3921 elderly
urban residents aged 75, 80, 85, 90, and 95 years. Of these, 3219 were home
dwellers.
Main Outcomes Measures Prevalence of potentially inappropriate drugs and prevalence of drugs
considered inappropriate related to 15 common medical conditions according
to recommendations given by the expert panel in 1997.
Results The response rate was 78%. Of the respondents, 12.5%, 1.3%, and 0.2%
were taking at least 1, 2, or 3 inappropriate drugs, respectively. The most
prevalent inappropriate drugs were dipyridamole (3.6%), long-acting benzodiazepines
(2.6%), amitriptyline hydrochloride (1.6%), ergot mesyloids (1.6%), muscle
relaxants (1.2%), and meprobamate (1.1%). Use of medications considered inappropriate
with certain medical conditions was higher: 27.2% of patients with chronic
obstructive pulmonary disease were taking -blockers and 19.3% used sedatives.
Of diabetic individuals taking oral hypoglycemics or insulin, 32.5% were taking
a concomitant -blocker. Of those with a peripheral vascular disease,
37.9% were taking -blockers. However, two thirds of all these patient
groups had concomitant coronary heart disease.
Conclusions Compared with previous surveys, the use of inappropriate medications
in our home-dwelling, elderly population is conspicuously low. In contrast,
use of certain drugs considered inappropriate with different medical conditions
was relatively high. However, the inappropriateness of the latter treatments
may be questioned in individual patients.
From the Department of Medicine, Geriatric Clinic, Helsinki University
Hospital, Helsinki, Finland.
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