Tags

Type your tag names separated by a space and hit enter

Polypharmacy and prescribing quality in older people.
J Am Geriatr Soc. 2006 Oct; 54(10):1516-23.JA

Abstract

OBJECTIVES

To evaluate the relationship between inappropriate prescribing, medication underuse, and the total number of medications used by patients.

DESIGN

Cross-sectional study.

SETTING

Veterans Affairs Medical Center.

PARTICIPANTS

One hundred ninety-six outpatients aged 65 and older who were taking five or more medications.

MEASUREMENTS

Inappropriate prescribing was assessed using a combination of the Beers drugs-to-avoid criteria (2003 update) and subscales of the Medication Appropriateness Index that assess whether a drug is ineffective, not indicated, or unnecessary duplication of therapy. Underuse was assessed using the Assessment of Underutilization of Medications instrument. All vitamins and minerals, topical and herbal medications, and medications taken as needed were excluded from the analyses.

RESULTS

Mean age was 74.6, and patients used a mean+/-standard deviation of 8.1+/-2.5 medications (range 5-17). Use of one or more inappropriate medications was documented in 128 patients (65%), including 73 (37%) taking a medication in violation of the Beers drugs-to-avoid criteria and 112 (57%) taking a medication that was ineffective, not indicated, or duplicative. Medication underuse was observed in 125 patients (64%). Together, inappropriate use and underuse were simultaneously present in 82 patients (42%), whereas 25 (13%) had neither inappropriate use nor underuse. When assessed by the total number of medications taken, the frequency of inappropriate medication use rose sharply from a mean of 0.4 inappropriate medications in patients taking five to six drugs, to 1.1 inappropriate medications in patients taking seven to nine drugs, to 1.9 inappropriate medications in patients taking 10 or more drugs (P<.001). In contrast, the frequency of underuse averaged 1.0 underused medications per patient and did not vary with the total number of medications taken (P=.26). Overall, patients using fewer than eight medications were more likely to be missing a potentially beneficial drug than to be taking a medication considered inappropriate.

CONCLUSION

Inappropriate medication use and underuse were common in older people taking five or more medications, with both simultaneously present in more than 40% of patients. Inappropriate medication use is most frequent in patients taking many medications, but underuse is also common and merits attention regardless of the total number of medications taken.

Authors+Show Affiliations

Division of Geriatrics, San Francisco Veterans Affairs Medical Center, and Department of Medicine, University of California at San Francisco, California 94121, USA. mike.steinman@ucsf.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

17038068

Citation

Steinman, Michael A., et al. "Polypharmacy and Prescribing Quality in Older People." Journal of the American Geriatrics Society, vol. 54, no. 10, 2006, pp. 1516-23.
Steinman MA, Landefeld CS, Rosenthal GE, et al. Polypharmacy and prescribing quality in older people. J Am Geriatr Soc. 2006;54(10):1516-23.
Steinman, M. A., Landefeld, C. S., Rosenthal, G. E., Berthenthal, D., Sen, S., & Kaboli, P. J. (2006). Polypharmacy and prescribing quality in older people. Journal of the American Geriatrics Society, 54(10), 1516-23.
Steinman MA, et al. Polypharmacy and Prescribing Quality in Older People. J Am Geriatr Soc. 2006;54(10):1516-23. PubMed PMID: 17038068.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Polypharmacy and prescribing quality in older people. AU - Steinman,Michael A, AU - Landefeld,C Seth, AU - Rosenthal,Gary E, AU - Berthenthal,Daniel, AU - Sen,Saunak, AU - Kaboli,Peter J, PY - 2006/10/14/pubmed PY - 2006/12/9/medline PY - 2006/10/14/entrez SP - 1516 EP - 23 JF - Journal of the American Geriatrics Society JO - J Am Geriatr Soc VL - 54 IS - 10 N2 - OBJECTIVES: To evaluate the relationship between inappropriate prescribing, medication underuse, and the total number of medications used by patients. DESIGN: Cross-sectional study. SETTING: Veterans Affairs Medical Center. PARTICIPANTS: One hundred ninety-six outpatients aged 65 and older who were taking five or more medications. MEASUREMENTS: Inappropriate prescribing was assessed using a combination of the Beers drugs-to-avoid criteria (2003 update) and subscales of the Medication Appropriateness Index that assess whether a drug is ineffective, not indicated, or unnecessary duplication of therapy. Underuse was assessed using the Assessment of Underutilization of Medications instrument. All vitamins and minerals, topical and herbal medications, and medications taken as needed were excluded from the analyses. RESULTS: Mean age was 74.6, and patients used a mean+/-standard deviation of 8.1+/-2.5 medications (range 5-17). Use of one or more inappropriate medications was documented in 128 patients (65%), including 73 (37%) taking a medication in violation of the Beers drugs-to-avoid criteria and 112 (57%) taking a medication that was ineffective, not indicated, or duplicative. Medication underuse was observed in 125 patients (64%). Together, inappropriate use and underuse were simultaneously present in 82 patients (42%), whereas 25 (13%) had neither inappropriate use nor underuse. When assessed by the total number of medications taken, the frequency of inappropriate medication use rose sharply from a mean of 0.4 inappropriate medications in patients taking five to six drugs, to 1.1 inappropriate medications in patients taking seven to nine drugs, to 1.9 inappropriate medications in patients taking 10 or more drugs (P<.001). In contrast, the frequency of underuse averaged 1.0 underused medications per patient and did not vary with the total number of medications taken (P=.26). Overall, patients using fewer than eight medications were more likely to be missing a potentially beneficial drug than to be taking a medication considered inappropriate. CONCLUSION: Inappropriate medication use and underuse were common in older people taking five or more medications, with both simultaneously present in more than 40% of patients. Inappropriate medication use is most frequent in patients taking many medications, but underuse is also common and merits attention regardless of the total number of medications taken. SN - 0002-8614 UR - https://www.unboundmedicine.com/medline/citation/17038068/Polypharmacy_and_prescribing_quality_in_older_people_ L2 - https://doi.org/10.1111/j.1532-5415.2006.00889.x DB - PRIME DP - Unbound Medicine ER -