Defining inappropriate practices in prescribing for elderly people: a national consensus panel.
OBJECTIVE
To develop a consensus-based list of inappropriate practices in prescribing for elderly people.


METHODS
Mail survey of a 32-member national panel.


METHODS
Academic medical centres across Canada.


METHODS
Thirty-two specialists selected arbitrarily, including 7 clinical pharmacologists, 9 geriatricians, 8 family practitioners and 8 pharmacists.


METHODS
Consensus that the practice would introduce a substantial and significant increase in the risk of serious adverse effect and is common enough that its curtailment would decrease morbidity among elderly people, ranking of clinical importance of the risk, and availability of equally or more effective and less risky alternative therapy.


RESULTS
The 32-member national panel developed a list of 71 practices in prescribing for elderly people and rated the clinical significance of each on a scale of 1 (not significant) to 4 (highly significant). The practices in prescribing identified fell into 3 categories: drugs generally contraindicated for elderly people, drug-disease interactions and drug-drug interactions. The mean significance rating was greater than 3 for 39 practices. For each practice, alternative therapies were recommended. There was surprising congruence among the specialists on the significance rating and the suggested alternative therapies.


CONCLUSIONS
The authors have developed a valid, relevant list of inappropriate practices in prescribing for elderly people, to be used in a practice-based intervention study.
McLeod
P J
PJ
Department of Medicine, McGill University, Montreal, Que.
Huang
A R
AR
Tamblyn
R M
RM
Gayton
D C
DC
D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D002170:Canada; D002317:Cardiovascular Agents / Q000627:therapeutic use; D004347:Drug Interactions; D011307:Drug Prescriptions / Q000592:standards*; D006801:Humans; D011619:Psychotropic Drugs / Q000627:therapeutic use; D011795:Surveys and Questionnaires
D000894:Anti-Inflammatory Agents, Non-Steroidal; D002317:Cardiovascular Agents; D011619:Psychotropic Drugs