Potential Inappropriate Medication Prescribing in the Elderly Using the Guidelines of “Beers' Criteria”

Background:

It has been estimated that 30% of hospital admissions are related to adverse drug events (ADE), at a high financial and human consequences. ADE occur most frequently in the elderly and may be preventable. The recognition and prevention of drug related problems in elderly patients is one the principal health care quality and safety issue to deal with. Beers and his colleagues have identified certain drugs that are potentially inappropriate for the elderly. We were interested in how frequently these drugs are prescribed to our elderly patients and whether these resulted in admission for ADEs.

Method:

We conducted a retrospective study reviewing discharge medications in 1406 consecutive charts of elderly individuals age 65 years and above from a Rio Grande Valley Community Hospital (RGVCH) against the Beer's criteria to determine the frequency of prescription of potential inappropriate medications (PIM). We also determined which specialties frequently prescribe them and monitored both ER and hospital subsequent admissions for adverse events.

Summary of Results:

Of the 1406 charts reviewed, 638 (47.1%) had at least one PIM. Average number of PIM per patient was 1.36 (range 1‐5). The 5 most frequently prescribed PI Ms are propoxyphene, benzodiazepines, clonidine, anti‐depressives, and promethazine. Family Practice (40.2%), Internal Medicine (19.9%), Orthopedics (17.1%), Oncology (12.7%), and Cardiology (10.1%) were most likely to prescribe these medications. Among the 1406 patients 28.7% (403) had readmission or ER visit for an ADE. 58.1% (234) of which were on PIM and 41.9% (169) were not on PIM with a relative risk of 1.56. The most common ADEs are: depression 152 (37.7%), falls 149 (37.0%), syncope 62 (15.8%), dizziness 39 (7.8%), and confusion 9 (2.2%).

Statement of Conclusions:

We observed that PIM are frequently prescribed to our elderly patients by a wide range of physicians. Those patients prescribed a PIM are 1.56 times more likely to suffer an ADE symptom syndrome. Although the “Beers criteria” is well known among geriatricians it would appear this is not the case among practicing physicians in this institution giving a potential room for improvement through physician education.

Author Disclosure Block:

O.D. Modi, None.