Potentially inappropriate prescribing including under-use amongst older patients with cognitive or psychiatric co-morbidities.
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.
Lang
Pierre Olivier
PO
Department of Rehabilitation and Geriatrics, Medical School and University Hospitals of Geneva, Geneva, Switzerland. pierre.o.lang@hcuge.ch
Hasso
Yasmine
Y
Dramé
Moustapha
M
Vogt-Ferrier
Nicole
N
Prudent
Max
M
Gold
Gabriel
G
Michel
Jean Pierre
JP
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
D011619:Psychotropic Drugs