Inappropriate medication use among frail elderly inpatients.
BACKGROUND
Inappropriate prescribing in frail elderly inpatients has not received as much investigation as in frail elderly nursing home patients.


OBJECTIVE
To determine the prevalence and predictors of inappropriate prescribing for hospitalized frail elderly patients.


METHODS
The study was conducted at 11 Veterans Affairs Medical Centers and involved a sample of 397 frail elderly inpatients. Inappropriate prescribing was measured by physician-pharmacist pair's consensus ratings for 10 criteria on the Medication Appropriateness Index (MAI). The MAI ratings generated a weighted score of 0-18 per medication (higher score = more inappropriate) and were summed across medications to achieve a patient score.


RESULTS
Overall, 365 (91.9%) patients had > or =1 medications with > or =1 MAI criteria rated as inappropriate. The most common problems involved expensive drugs (70.0%), impractical directions (55.2%), and incorrect dosages (50.9%). The most common drug classes with appropriateness problems were gastric (50.6%), cardiovascular (47.6%), and central nervous system (23.9%). The mean +/- SD MAI score per person was 8.9 +/- 7.6. Stepwise ordinal logistic regression analyses revealed that both the number of prescription (adjusted OR 1.28; 95% CI 1.21 to 1.36) and nonprescription drugs (adjusted OR 1.17; 95% CI 1.06 to 1.29) were related to higher MAI scores. Analyses excluding the number of drugs revealed that the Charlson index (adjusted OR 1.62; 95% CI 1.12 to 2.35) and fair/poor self-rated health (adjusted OR 1.15; 95% CI 1.05 to 1.26) were related to higher MAI scores.


CONCLUSIONS
Inappropriate drug prescribing is common for frail elderly veteran inpatients and is related to polypharmacy and specific health status characteristics.
Hanlon
Joseph T
JT
Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, MN 55455, USA. hanlo004@tc.umn.edu
Artz
Margaret B
MB
Pieper
Carl F
CF
Lindblad
Catherine I
CI
Sloane
Richard J
RJ
Ruby
Christine M
CM
Schmader
Kenneth E
KE
D000368:Aged; D003625:Data Collection; D003710:Demography; D011307:Drug Prescriptions / Q000145:classification / Q000706:statistics & numerical data; D017723:Drug Utilization Review; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D016330:Frail Elderly; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007297:Inpatients; D007400:Interprofessional Relations; D008297:Male; D004364:Pharmaceutical Preparations / Q000008:administration & dosage; D011785:Quality Assurance, Health Care; D014728:Veterans
D004364:Pharmaceutical Preparations