title: Unnecessary drug use in frail older people at hospital discharge.
abstract: OBJECTIVE
  To determine the prevalence and predictors of unnecessary drug use at hospital discharge in frail elderly patients.
  
  
  METHODS
  Cross-sectional.
  
  
  METHODS
  Eleven Veterans Affairs Medical Centers.
  
  
  METHODS
  Three hundred eighty-four frail older patients from the Geriatric Evaluation and Management Drug Study.
  
  
  METHODS
  Assessment of unnecessary drug use was determined by the consensus of a clinical pharmacist and physician pair applying the Medication Appropriateness Index to each regularly scheduled medication at hospital discharge. Those drugs that received an inappropriate rating for indication, efficacy, or therapeutic duplication were defined as unnecessary.
  
  
  RESULTS
  Forty-four percent of patients had at least one unnecessary drug, with the most common reason being lack of indication. The most commonly prescribed unnecessary drug classes were gastrointestinal, central nervous system, and therapeutic nutrients/minerals. Factors associated (P<.05) with unnecessary drug use included hypertension (adjusted odds ratio (AOR)=0.61, 95% confidence interval (CI)=0.38-0.96), multiple prescribers (AOR=3.35, 95% CI=1.16-9.68), and nine or more medications (AOR=2.24, 95% CI=1.25-3.99).
  
  
  CONCLUSIONS
  A high prevalence of unnecessary drug use at discharge was found in frail hospitalized elderly patients. Additional studies are needed to identify predictors and prevalence of unnecessary drug use in nonveteran populations so that interventions can be designed to reduce the problem.
authors.affiliation: Philadelphia College of Pharmacy, University of the Sciences in Philadelphia, Pennsylvania 19104, USA. e.hajjar@usip.edu
authors.forename: Emily R
authors.initials: ER
authors.lastname: Hajjar
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Hanlon
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Sloane
authors.forename: Catherine I
authors.initials: CI
authors.lastname: Lindblad
authors.forename: Carl F
authors.initials: CF
authors.lastname: Pieper
authors.forename: Christine M
authors.initials: CM
authors.lastname: Ruby
authors.forename: Laurence C
authors.initials: LC
authors.lastname: Branch
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Schmader
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D011307:Drug Prescriptions / Q000592:standards*; D005260:Female; D016330:Frail Elderly; D006801:Humans; D008297:Male; D010351:Patient Discharge; D019338:Polypharmacy