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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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