title: Potentially inappropriate prescribing and adverse drug reactions in the elderly: a population-based study.
abstract: OBJECTIVE
  Potentially inappropriate prescriptions (PIPs) criteria are widely used for evaluating the quality of prescribing in elderly. However, there is limited evidence on their association with adverse drug reactions (ADRs) across healthcare settings. The study aimed to determine the prevalence of PIPs, defined by the Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria, in the Swedish elderly general population and to investigate the association between PIPs and occurrence of ADRs.
  
  
  METHODS
  Persons ≥65 years old were identified from a random sample of 5025 adults drawn from the Swedish Total Population Register. A retrospective cohort study was conducted among 813 elderly with healthcare encounters in primary and specialised healthcare settings during a 3-month period in 2008. PIPs were identified from the Swedish Prescribed Drug Register, medical records and health administrative data. ADRs were independently identified by expert reviewers in a stepwise manner using the Howard criteria. Multivariable logistic regression examined the association between PIPs and ADRs.
  
  
  RESULTS
  Overall, 374 (46.0 %) persons had ≥1 PIPs and 159 (19.5 %) experienced ≥1 ADRs during the study period. In total, 29.8 % of all ADRs was considered caused by PIPs. Persons prescribed with PIPs had more than twofold increased odds of experiencing ADRs (OR 2.47; 95 % CI 1.65-3.69). PIPs were considered the cause of 60 % of ADRs affecting the vascular system, 50 % of ADRs affecting the nervous system and 62.5 % of ADRs resulting in falls.
  
  
  CONCLUSIONS
  PIPs are common among the Swedish elderly and are associated with increased odds of experiencing ADRs. Thus, interventions to decrease PIPs may contribute to preventing ADRs, in particular ADRs associated with nervous and vascular disorders and falls.
authors.affiliation: Division of Drug Research, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden. khedidja.hedna@liu.se.|Nordic School of Public Health NHV, Gothenburg, Sweden. khedidja.hedna@liu.se.
authors.forename: Khedidja
authors.initials: K
authors.lastname: Hedna
authors.affiliation: Nordic School of Public Health NHV, Gothenburg, Sweden.|EPID Research, Espoo, Finland.
authors.forename: Katja M
authors.initials: KM
authors.lastname: Hakkarainen
authors.affiliation: Nordic School of Public Health NHV, Gothenburg, Sweden.|Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
authors.forename: Hanna
authors.initials: H
authors.lastname: Gyllensten
authors.affiliation: Department of Clinical Pharmacology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: Anna K
authors.initials: AK
authors.lastname: Jönsson
authors.affiliation: Centre for Applied Biostatistics, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Max
authors.initials: M
authors.lastname: Petzold
authors.affiliation: Division of Drug Research, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.|Futurum, Jönköping County Council, Jönköping, Sweden.
authors.forename: Staffan
authors.initials: S
authors.lastname: Hägg
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology*; D005260:Female; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D009422:Nervous System Diseases / Q000139:chemically induced / Q000453:epidemiology; D010818:Practice Patterns, Physicians' / Q000592:standards* / Q000706:statistics & numerical data; D015995:Prevalence; D011320:Primary Health Care / Q000592:standards; D012042:Registries; D012189:Retrospective Studies; D013548:Sweden / Q000453:epidemiology; D014652:Vascular Diseases / Q000139:chemically induced / Q000453:epidemiology
keywords: Adverse drug reactions; Elderly; Inappropriate prescribing; Medical records; Registries; Retrospective study