Inappropriate medication prescribing for elderly ambulatory care patients.
BACKGROUND
Inappropriate medication use in elderly patients has been linked to a large share of adverse drug reactions and to excess health care utilization.


METHODS
Trends in the prevalence of potentially inappropriate drug prescribing at ambulatory care visits by elderly persons from 1995 to 2000 were examined with data from office-based physicians in the National Ambulatory Medical Care Survey and from hospital outpatient departments in the National Hospital Ambulatory Medical Care Survey. Explicit criteria were used to identify potentially inappropriate prescribing. Multivariate regression was used to identify related factors.


RESULTS
In 1995 and 2000, at least 1 drug considered inappropriate by the Beers expert panel was prescribed at 7.8% of ambulatory care visits by elderly patients. At least 1 drug classified as never or rarely appropriate by the Zhan expert panel was prescribed at 3.7% and 3.8% of these visits in 1995 and 2000, respectively. Pain relievers and central nervous system drugs were a large share of the problem. The odds of potentially inappropriate prescribing were higher for visits with multiple drugs and double for female visits. The latter was due to more prescribing of potentially inappropriate pain relievers and central nervous system drugs.


CONCLUSIONS
Potentially inappropriate prescribing at ambulatory care visits by elderly patients, particularly women, remains a substantial problem. Interventions could target more appropriate drug selection by physicians when prescribing pain relievers, antianxiety agents, sedatives, and antidepressants to elderly patients. Such behavior could eliminate a large portion of inappropriate prescribing for elderly patients and reduce its higher risk for women.
Goulding
Margie Rauch
MR
Office of Analysis, Epidemiology, and Health Promotion at the National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD 20782, USA. mgoulding@cdc.gov
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000639:trends; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D001007:Anxiety / Q000188:drug therapy; D002491:Central Nervous System Agents / Q000009:adverse effects / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D003863:Depression / Q000188:drug therapy; D011307:Drug Prescriptions; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008508:Medication Errors / Q000517:prevention & control / Q000706:statistics & numerical data / Q000639:trends*; D008875:Middle Aged; D015999:Multivariate Analysis; D009819:Office Visits / Q000706:statistics & numerical data / Q000639:trends; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data / Q000639:trends; D010146:Pain / Q000188:drug therapy; D010817:Physician-Patient Relations; D010821:Physicians, Family / Q000706:statistics & numerical data / Q000639:trends; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D015995:Prevalence; D011787:Quality of Health Care; D011897:Random Allocation; D013223:Statistics as Topic; D014481:United States / Q000453:epidemiology
D000701:Analgesics, Opioid; D000928:Antidepressive Agents; D002491:Central Nervous System Agents