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GERIATRICS

Inappropriate Medication Use Among Frail Elderly Inpatients

Professor, VFW Endowed Chair-Pharmacotherapy for the Elderly, Department of Experimental and Clinical Pharmacology; Director, Institute for the Study of Geriatric Pharmacotherapy, College of Pharmacy, University of Minnesota, Minneapolis, MN; Clinical Pharmacist Specialist in Geriatrics, Geriatric Research, Education, and Clinical Center, Minneapolis Veterans Affairs Medical Center, Minneapolis

Margaret B Artz, PhD

Assistant Professor, Department of Experimental and Clinical Pharmacology and Research Associate, Institute for the Study of Geriatric Pharmacotherapy, College of Pharmacy, University of Minnesota

Carl F Pieper, DrPH

Associate Professor, Department of Biostatistics and Bioinformatics; Director, Computer and Biostatistical Lab, Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC

Catherine I Lindblad, PharmD

Assistant Professor, Department of Experimental and Clinical Pharmacology, and Research Associate, Institute for the Study of Geriatric Pharmacotherapy, College of Pharmacy, University of Minnesota; Clinical Pharmacist Specialist in Geriatrics, Minneapolis Veterans Affairs Medical Center

Richard J Sloane, MPH

Biostatistician, Computer and Biostatistical Lab, Center for the Study of Aging and Human Development, Duke University Medical Center

Christine M Ruby, PharmD

Adjunct Assistant Professor, School of Pharmacy, University of North Carolina, Chapel Hill, NC; Senior Fellow, Center for the Study of Aging and Human Development and Assistant Research Professor, Department of Medicine, Division of Geriatrics, Duke University Medical Center; Clinical Pharmacist Specialist in Geriatrics, Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs Medical Center

Kenneth E Schmader, MD

Senior Fellow, Center for the Study of Aging and Human Development; Associate Professor, Department of Medicine, Division of Geriatrics, Duke University Medical Center; Staff Physician, Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs Medical Center

Reprints: Joseph T Hanlon PharmD MS, Institute for the Study of Geriatric Pharmacotherapy, College of Pharmacy, 7-115 Weaver-Densford Hall, University of Minnesota, 308 Harvard St. SE, Minneapolis, MN 55455-0353, fax 612/626-6095, hanlo004{at}tc.umn.edu

BACKGROUND: Inappropriate prescribing in frail elderly inpatients has not received as much investigation as in frail elderly nursing home patients.

OBJECTIVE: To determine the prevalence and predictors of inappropriate prescribing for hospitalized frail elderly patients.

METHODS: The study was conducted at 11 Veterans Affairs Medical Centers and involved a sample of 397 frail elderly inpatients. Inappropriate prescribing was measured by physician–pharmacist pair's consensus ratings for 10 criteria on the Medication Appropriateness Index (MAI). The MAI ratings generated a weighted score of 0–18 per medication (higher score = more inappropriate) and were summed across medications to achieve a patient score.

RESULTS: Overall, 365 (91.9%) patients had 1 medications with 1 MAI criteria rated as inappropriate. The most common problems involved expensive drugs (70.0%), impractical directions (55.2%), and incorrect dosages (50.9%). The most common drug classes with appropriateness problems were gastric (50.6%), cardiovascular (47.6%), and central nervous system (23.9%). The mean ± SD MAI score per person was 8.9 ± 7.6. Stepwise ordinal logistic regression analyses revealed that both the number of prescription (adjusted OR 1.28; 95% CI 1.21 to 1.36) and nonprescription drugs (adjusted OR 1.17; 95% CI 1.06 to 1.29) were related to higher MAI scores. Analyses excluding the number of drugs revealed that the Charlson index (adjusted OR 1.62; 95% CI 1.12 to 2.35) and fair/poor self-rated health (adjusted OR 1.15; 95% CI 1.05 to 1.26) were related to higher MAI scores.

CONCLUSIONS: Inappropriate drug prescribing is common for frail elderly veteran inpatients and is related to polypharmacy and specific health status characteristics.

Key Words: drug utilization, elderly, epidemiology, quality of care

Published Online, November 17, 2003. www.theannals.com, DOI 10.1345/aph.1D313

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