[Assessment of inappropriate prescribing in the elderly subject during acute care hospitalisation]

Abstract

Objective: Inappropriate prescribing in elderly is considered as common (40% of subjects from community from the 3CStudy in France had a inappropriate prescription, using Beer's criteria), and can lead to severe issues. Few studies have assessed inappropriate prescribing for elderly inpatients in acute care, with multiple tools. Our study was designed to assess outcome prescriptions concordance of elderly inpatients, for potentially inappropriate medication use.

Methods: A retrospective study based on a random sample of 170 inpatients in 2009 was performed at Nantes University Hospital. We used standardized tools, especially general prescriptions rules of the "Collège professionnel des gériatres français", Beers's criteria, the Anticholinergic Risk Scale, concordance for renal function, and search for medication with tight therapeutic edge.

Results: Mean age of inpatients was 85.2 ± 4.1 years. Median numbers of prescribing drugs was eight. General prescriptions rules were followed up to 90% of inpatients: no forbidden drug-drug interaction was found. However, more than two psychotropic medications were prescribed for 3.9% of inpatients. At least one drug listed in Beers's criteria were found for 41 (27.0%) inpatients: amiodarone (18 inpatients) and long-term benzodiazepines (seven inpatients). A medication from the anticholinergic risk scale was found for 28 subjects (18.6%): however, for only seven of them, the score was higher than 3. Concordance for renal function was required for 126 inpatients (82.9%) for at least one prescription, 9 (7.1%) patients have a medication overdose according to their renal impairment. Medications with tight therapeutic edge were prescribed for 52 subjects (34.2%): mostly oral anticoagulants (27 subjects). In 15 cases, the dose was underneath the recommended level.

Conclusion: Some potentially inappropriate medication uses were revealed by our study. It is essential to spread out results for clinicians, for a better knowledge of these risks.