Appropriateness of medication selection for older persons in an urban academic emergency department.
OBJECTIVE
To determine the frequency of potentially inappropriate medication selection for older persons presenting to the ED, the most common problematic drugs, risk factors for suboptimal medication selection, and whether use of these medications is associated with worse outcomes.


METHODS
The authors performed a prospective cohort study of 898 patients 65 years or older who presented to an urban academic ED in 1995 and 1996. Seventy-nine percent of the patients were African-American and 43% did not graduate from high school. Potentially inappropriate medications and adverse drug-disease interactions were identified using the 1997 Beers explicit criteria for elders. During the three months after the initial visit, revisits to the ED or hospital, death, and changes in health-related quality of life were analyzed as measured by validated questions adapted from the Medical Outcomes Study.


RESULTS
Upon presentation, 10.6% of the patients were taking a potentially inappropriate medication, 3.6% were given one in the ED, and 5.6% were prescribed one upon discharge from the ED. The most frequently prescribed potentially inappropriate medications in the ED were diphenhydramine, indomethacin, meperidine, and cyclobenzaprine. Emergency physicians added potentially inappropriate medications most often to patients with discharge diagnoses of musculoskeletal disorder, back pain, gout, and allergy or urticaria. Potentially adverse drug-disease interactions were relatively uncommon at presentation (5.2%), in the ED (0.6%), and on discharge from the ED (1.2%). Potentially inappropriate medications and adverse drug-disease interactions prescribed in the ED were not associated with higher rates of revisit to the ED, hospitalization, or death, but were correlated with worse physical function and pain. However, confidence intervals were wide for analyses of revisits and death.


CONCLUSIONS
Suboptimal medication selection was fairly common and was associated with worse patient-reported health-related quality of life.
Chin
M H
MH
Section of General Internal Medicine, University of Chicago, IL 60637, USA. mchin@medicine.bsd.uchicago.edu
Wang
L C
LC
Jin
L
L
Mulliken
R
R
Walter
J
J
Hayley
D C
DC
Karrison
T G
TG
Nerney
M P
MP
Miller
A
A
Friedmann
P D
PD
D000058:Accidental Falls / Q000517:prevention & control / Q000706:statistics & numerical data; D000368:Aged; D002318:Cardiovascular Diseases / Q000150:complications / Q000188:drug therapy; D002641:Chicago; D015331:Cohort Studies; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000188:drug therapy; D004347:Drug Interactions; D017723:Drug Utilization Review / Q000592:standards* / Q000706:statistics & numerical data / Q000639:trends; D004636:Emergency Service, Hospital / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008508:Medication Errors / Q000706:statistics & numerical data*; D010437:Peptic Ulcer / Q000150:complications / Q000188:drug therapy; D011446:Prospective Studies; D011787:Quality of Health Care; D011788:Quality of Life; D012140:Respiratory Tract Diseases / Q000150:complications / Q000188:drug therapy; D018570:Risk Assessment; D014505:Urban Population; D014947:Wounds and Injuries / Q000150:complications*