Pharmaceutical Research

Potentially inappropriate drugs are commonly prescribed for elderly outpatients

In 1999, one in five (21 percent) of elderly individuals filled a prescription for a drug that in general should be avoided in patients aged 65 and older. In addition, nearly half (44 percent) of these prescriptions were for drugs that carry a substantial risk of adverse effects in elderly patients, according to a study supported by the Agency for Healthcare Research and Quality through the Centers for Education and Research on Therapeutics (HS10385) program. The researchers used an outpatient prescription claims database to identify prescriptions filled for commercially insured patients aged 65 and older in 1999.

More than 15 percent of the patients filled prescriptions for two drugs of concern, and 4 percent filled prescriptions for three or more drugs of concern within the same year. Nearly 28 percent of the patients filled a prescription for a psychotropic drug (16 percent filled at least one prescription for the antidepressant, amitriptyline), and 5 percent filled a prescription for a neuromuscular agent (of these, 14 percent filled a prescription for cyclobenzaprine). Both of these drug classes are considered problematic for use in elderly patients.

To improve drug prescribing for the elderly, the researchers suggest that clinical trials should be designed to encourage enrollment of elderly patients, use of pharmaceutical claims databases for identifying patients with claims for drugs of concern, and monitoring problems over time to quantify the hazards associated with use of these drugs in older patients. They also encourage use of systems and technologies that support optimal prescribing behavior, such as computerized physician order entry with decision support and personal digital assistants.

See "Inappropriate prescribing for elderly Americans in a large outpatient population," by Lesley H. Curtis, Ph.D., Truls Ostbye, M.D., Ph.D., Veronica Sendersky, Pharm.D., and others, in the August 2004 Archives of Internal Medicine 154, pp. 1621-1625.

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