Inappropriate medication prescribing in homebound older adults.
OBJECTIVE
Little is known about the prescribing of medications in the growing population of homebound older adults. We report on the prevalence and pattern of inappropriate medications in a nursing home-eligible, homebound population.


METHODS
A cross-sectional design.


METHODS
A managed care plan for individuals meeting nursing home eligibility.


METHODS
2193 homebound people older than age 60.


METHODS
We reviewed the pharmacy profiles of all older homebound enrollees. We identified the average number of medications per patient and the most commonly prescribed classes of drugs. The medication profiles were also analyzed in the context of the 26 drugs/groups listed as inappropriate by the explicit criteria of Beers [Arch Intern Med 1997; 157:1531-1536].


RESULTS
A total of 2193 people aged 60 to 106 (mean 82.8 +/- 8.8) were taking an average of 5.3 +/- 2.9 drugs (range 0-22). Cardiac drugs and benzodiazepines were the medications most commonly prescribed. We found 1152 of the total 11,689 prescriptions (9.9%) to be inappropriate. Eight hundred seventy-one (39.7%) of these 2193 residents had at least one inappropriate prescription, and 230 (10.4%) had two or more. Of particular concern were 285 people prescribed excessive doses of temazepam and zoldipem, 211 people taking first-generation antihistamines, 115 taking doxepin or amitriptyline, 106 taking an ergoloid, 98 taking dipyridamole, and 85 prescribed a long-acting benzodiazepine.


CONCLUSIONS
Our study revealed a high prevalence of psychotropic medications and inappropriate drug use among older homebound residents, a group that is at the highest risk for adverse drug reactions. Because this group is not subject to oversight by regulatory agencies, further interventional studies and provider education will be important.
Golden
A G
AG
Department of Medicine, University of Miami School of Medicine, Miami Geriatric Research, Education, and Clinical Center, Veterans Affairs Medical Center, Florida 33125, USA.
Preston
R A
RA
Barnett
S D
SD
Llorente
M
M
Hamdan
K
K
Silverman
M A
MA
D000368:Aged; D000369:Aged, 80 and over; D000639:Amitriptyline / Q000627:therapeutic use; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D002317:Cardiovascular Agents / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D004176:Dipyridamole / Q000627:therapeutic use; D004316:Doxepin / Q000627:therapeutic use; D011307:Drug Prescriptions; D004363:Drug Utilization; D004877:Ergoloid Mesylates / Q000627:therapeutic use; D005260:Female; D006634:Histamine H1 Antagonists / Q000627:therapeutic use; D018577:Homebound Persons; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D008297:Male; D008508:Medication Errors; D008875:Middle Aged; D018697:Nootropic Agents / Q000627:therapeutic use; D019338:Polypharmacy; D010818:Practice Patterns, Physicians'; D015995:Prevalence; D011725:Pyridines / Q000627:therapeutic use; D013693:Temazepam / Q000627:therapeutic use; D014665:Vasodilator Agents / Q000627:therapeutic use; D000077334:Zolpidem
D014151:Anti-Anxiety Agents; D000929:Antidepressive Agents, Tricyclic; D002317:Cardiovascular Agents; D006634:Histamine H1 Antagonists; D006993:Hypnotics and Sedatives; D018697:Nootropic Agents; D011725:Pyridines; D014665:Vasodilator Agents; D004316:Doxepin; D000639:Amitriptyline; D004176:Dipyridamole; D000077334:Zolpidem; D004877:Ergoloid Mesylates; D013693:Temazepam