title: Potentially inappropriate prescribing including under-use amongst older patients with cognitive or psychiatric co-morbidities.
abstract: OBJECTIVE
  the study aimed to determine the prevalence of and risk factors for inappropriate prescribing (IP) and prescribing omission (PO) in elderly with mental co-morbidities.
  
  
  METHODS
  One hundred fifty consecutive inpatients with mental co-morbidities hospitalised for acute medical illness (mean age 80 +/- 9, 70% of women) were considered for the study.
  
  
  METHODS
  IP and PO were prospectively identified according to STOPP/START criteria at hospital admission.
  
  
  RESULTS
  over 95% were taking >or=1 medication (median = 7) which amounted to 1,137 prescriptions. The prevalence of IP was 77% and PO was 65%. The most frequent encountered IP concerned drugs adversely affecting fallers (25%) and antiaggregants therapy without atherosclerosis (14%). PO concerned antidepressants with moderate/severe depression (20%) and calcium-vitamin D supplementation (18%). Independent predictors for IP were increased number of concomitant drugs (odds ratio [OR] 1.54, 95% confidence interval [CI] 1.13-1.89), being cognitively impaired (OR 1.83, 95% CI 1.55-2.24), and having fallen in the preceding 3 months (OR 2.03, 95% CI 1.52-2.61) or hospitalised in the preceding year (OR 1.09, 95% CI 1.02-1.23). Concerning PO, psychiatric disorder (OR 1.64, 95% CI 1.42-2.01) and increase level of co-morbidities (OR 1.79, 95% CI 1.48-1.99) were identified. Living in an institutional setting was a predictive maker for both IP (OR 1.45, 95% CI 1.27-1.74) and PO (OR 1.67, 95% CI 1.32-1.91).
  
  
  CONCLUSIONS
  IP and PO were highly prevalent raising the need of a greater health literacy concerning geriatric conditions in non-geriatrician practitioners who care elderly as well as in the community, in hospital and institutional settings for improving quality and safety in prescribing medication.
authors.affiliation: Department of Rehabilitation and Geriatrics, Medical School and University Hospitals of Geneva, Geneva, Switzerland. pierre.o.lang@hcuge.ch
authors.forename: Pierre Olivier
authors.initials: PO
authors.lastname: Lang
authors.forename: Yasmine
authors.initials: Y
authors.lastname: Hasso
authors.forename: Moustapha
authors.initials: M
authors.lastname: Dramé
authors.forename: Nicole
authors.initials: N
authors.lastname: Vogt-Ferrier
authors.forename: Max
authors.initials: M
authors.lastname: Prudent
authors.forename: Gabriel
authors.initials: G
authors.lastname: Gold
authors.forename: Jean Pierre
authors.initials: JP
authors.lastname: Michel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D011307:Drug Prescriptions / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007297:Inpatients; D008297:Male; D008508:Medication Errors / Q000706:statistics & numerical data*; D001523:Mental Disorders / Q000188:drug therapy*; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data*; D015995:Prevalence; D011446:Prospective Studies; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D012307:Risk Factors
chemical_list: D011619:Psychotropic Drugs