title: Inappropriate prescribing in the hospitalized elderly patient: defining the problem, evaluation tools, and possible solutions.
abstract: Potentially inappropriate medication (PIM) prescribing in older adults is quite prevalent and is associated with an increased risk for adverse drug events, morbidity, and utilization of health care resources. In the acute care setting, PIM prescribing can be even more problematic due to multiple physicians and specialists who may be prescribing for a single patient as well as difficulty with medication reconciliation at transitions and limitations imposed by hospital formularies. This article highlights critical issues surrounding PIM prescribing in the acute care setting such as risk factors, screening tools, and potential strategies to minimize this significant public health problem.
authors.affiliation: Associate Professor of Clinical Pharmacy and Physical Medicine, Clinical Specialist, Division of Cardiology and Heart Transplantation. robert.page@ucdenver.edu
authors.forename: Robert L
authors.initials: RL
authors.lastname: Page
authors.forename: Sunny A
authors.initials: SA
authors.lastname: Linnebur
authors.forename: Lucinda L
authors.initials: LL
authors.lastname: Bryant
authors.forename: J Mark
authors.initials: JM
authors.lastname: Ruscin
mesh_terms: D000368:Aged; D011307:Drug Prescriptions / Q000592:standards*; D005260:Female; D006801:Humans; D007297:Inpatients; D008297:Male; D008403:Mass Screening; D008508:Medication Errors; D019338:Polypharmacy; D010818:Practice Patterns, Physicians'
references.citation: Arch Intern Med. 1991 Sep;151(9):1825-32
references.pmid: 1888249
references.citation: Am J Health Syst Pharm. 2003 Sep 1;60(17):1750-9
references.pmid: 14503111
references.citation: Consult Pharm. 2003 Jan;18(1):37-42, 47-9
references.pmid: 16563052
references.citation: Drugs Aging. 2008;25(8):693-706
references.pmid: 18665661
references.citation: Ann Pharmacother. 2005 Jul-Aug;39(7-8):1161-8
references.pmid: 15897265
references.citation: Int J Clin Pharmacol Ther. 2008 Feb;46(2):72-83
references.pmid: 18218287
references.citation: J Am Geriatr Soc. 2007 May;55(5):658-65
references.pmid: 17493184
references.citation: Age Ageing. 2008 Jan;37(1):96-101
references.pmid: 17933759
references.citation: Arch Intern Med. 1997 Jul 28;157(14):1531-6
references.pmid: 9236554
references.citation: Br J Clin Pharmacol. 2007 Feb;63(2):177-86
references.pmid: 17166186
references.citation: Ann Pharmacother. 2004 Jan;38(1):9-14
references.pmid: 14742785
references.citation: Arch Intern Med. 1999 Nov 22;159(21):2553-60
references.pmid: 10573045
references.citation: Ann Intern Med. 2009 Feb 3;150(3):178-87
references.pmid: 19189907
references.citation: Med Care. 2007 Jan;45(1):95-9
references.pmid: 17279026
references.citation: CMAJ. 2003 Sep 16;169(6):549-56
references.pmid: 12975221
references.citation: Am J Geriatr Pharmacother. 2004 Dec;2(4):257-64
references.pmid: 15903284
references.citation: Am J Med. 2004 Mar 15;116(6):394-401
references.pmid: 15006588
references.citation: J Clin Epidemiol. 1994 Aug;47(8):891-6
references.pmid: 7730892
references.citation: N Engl J Med. 2003 Apr 17;348(16):1556-64
references.pmid: 12700376
references.citation: Gerontologist. 2008 Aug;48(4):537-41
references.pmid: 18728303
references.citation: Exp Gerontol. 2003 Aug;38(8):843-53
references.pmid: 12915206
references.citation: Am J Geriatr Pharmacother. 2006 Dec;4(4):297-305
references.pmid: 17296535
references.citation: Am J Med. 1996 Apr;100(4):428-37
references.pmid: 8610730
references.citation: JAMA. 2008 Dec 24;300(24):2867-78
references.pmid: 19109115
references.citation: Am J Geriatr Pharmacother. 2007 Dec;5(4):345-51
references.pmid: 18179993
references.citation: J Gen Intern Med. 2008 Jan;23 Suppl 1:32-6
references.pmid: 18095041
references.citation: Lancet. 2007 Jul 14;370(9582):173-184
references.pmid: 17630041
references.citation: Medsurg Nurs. 2008 Oct;17(5):332-6
references.pmid: 19051982
references.citation: Eur J Clin Pharmacol. 2003 Jun;59(2):157-62
references.pmid: 12734610
references.citation: J Hosp Med. 2008 Mar;3(2):91-102
references.pmid: 18438805
references.citation: Clin Pharmacokinet. 1997 Oct;33(4):302-12
references.pmid: 9342505
references.citation: Scand J Prim Health Care. 2008;26(2):80-5
references.pmid: 18570005
references.citation: Am J Ther. 2007 Sep-Oct;14(5):488-98
references.pmid: 17890940
references.citation: J Am Geriatr Soc. 2005 Sep;53(9):1518-23
references.pmid: 16137281
references.citation: Eur J Clin Pharmacol. 2005 Dec;61(12):921-8
references.pmid: 16307267
references.citation: Am J Geriatr Pharmacother. 2008 Jun;6(2):119-29
references.pmid: 18675770
references.citation: J Clin Pharm Ther. 2007 Apr;32(2):113-21
references.pmid: 17381661
references.citation: Arch Intern Med. 2008 May 26;168(10):1090-6
references.pmid: 18504337
references.citation: Ann Intern Med. 1993 Feb 1;118(3):219-23
references.pmid: 8417639
references.citation: Ann Pharmacother. 2009 Jul;43(7):1239-44
references.pmid: 19584381
references.citation: J Clin Pharm Ther. 2006 Dec;31(6):617-26
references.pmid: 17176367
references.citation: J Clin Epidemiol. 1992 Oct;45(10):1045-51
references.pmid: 1474400
references.citation: Arch Intern Med. 2005 Sep 12;165(16):1842-7
references.pmid: 16157827
references.citation: Can J Clin Pharmacol. 2000 Summer;7(2):103-7
references.pmid: 10958706
references.citation: Arch Intern Med. 2003 Dec 8-22;163(22):2716-24
references.pmid: 14662625
references.citation: JAMA. 1998 Apr 15;279(15):1200-5
references.pmid: 9555760
references.citation: N Engl J Med. 2009 Jan 15;360(3):225-35
references.pmid: 19144938
references.citation: Ann Intern Med. 2007 Jun 5;146(11):775-86
references.pmid: 17548409
references.citation: Arch Intern Med. 1990 Apr;150(4):841-5
references.pmid: 2327844
references.citation: N Engl J Med. 2009 Apr 2;360(14):1418-28
references.pmid: 19339721
references.citation: Age Ageing. 2008 Nov;37(6):673-9
references.pmid: 18829684
references.citation: Am J Emerg Med. 1996 Sep;14(5):447-50
references.pmid: 8765105