It is estimated that approximately half of adults, older than 65 years of age, have been prescribed potentially inappropriate medications (PIMs). This study’s objective was to determine the prevalence of PIM use among older patients. Two retrospective chart reviews were performed on 200 and 164 older patients who underwent comprehensive geriatric assessments (CGAs) at outpatient geriatrics clinics at the Glenrose Rehabilitation Hospital (Glenrose) in 2012–13 and at the Misericordia Community Hospital (Misericordia) in 2016–17, respectively. Outcome measures included demographics; prevalence of PIM use; common PIMs used; whether PIM use was addressed, and if so, how; and total number of oral medications. At the Glenrose, the prevalence of PIM use was 45 per cent (90/200). Of the 90 patients who had used PIMs, 46.7 per cent (42/90) had at least one of their medications stopped or modified. At the Misericordia, the prevalence of PIM use was 57.3 per cent (94/164). Of the 94 patients who used PIMs, 47.9 per cent (45/94) had at least one of their medications stopped or modified. These results suggest that an increased awareness of PIM among physicians is needed to further decrease PIM use.

This study systematically reviews the published literature regarding inappropriate prescribing in frail individuals aged at least 65 years. Twenty-five of 466 identified studies met the inclusion criteria. All papers measured some surrogate indicators of frailty, such as performance-based tests, cognitive function and functional dependency. Beers criteria were used in 20 studies (74%) to evaluate inappropriate medication use and 36% (9/25) studies used more than one criterion. The prevalence of inappropriate medications ranged widely from 11 to 92%. Only a few studies reported the relationship between potentially inappropriate medication use and surrogate measures of frailty. These diverse findings indicate the need for a standardized measure for assessing appropriateness of medication in frail older individuals. Prescribing tools should address both medication and patient-related factors such as life expectancy and functional status to minimize inappropriate prescribing in frail individuals.

Background: Given the potential adverse effects of antipsychotics, high use in nursing homes creates concern. Our study goal was to explore the use of antipsychotics in relation to resident characteristics, and to assess the appropriateness of antipsychotic prescribing in Belgian nursing homes.

Methods: Data were used from a cross-sectional study (Prescribing in Homes for the Elderly; PHEBE) conducted in 76 nursing homes in Belgium. Antipsychotics were classified into typical and atypical, using the anatomical therapeutic and chemical classification. Ten inappropriate antipsychotic prescribing indicators were selected from the updated Beers criteria (2003), Bergen District Nursing Home Study (BEDNURS) indicators, and Screening Tool of Older People's Prescriptions criteria (STOPP).

Results: The residents' mean age was 84.8 years, 78.1% of whom were female. The prevalence of antipsychotic utilization was 32.9%. Antipsychotics were mainly indicated for dementia-related agitation, and psychosis with/without dementia. Higher use of antipsychotics was found for dementia (OR: 3.27; 95% CI: 2.61–4.09), insomnia (OR: 1.38; 95% CI: 1.10–1.73), depression (OR: 1.30; 95% CI: 1.03–1.65), and age <80 years (OR: 1.79; 95% CI: 1.38–2.33). Inappropriate antipsychotic prescribing indicators scoring the highest among users were: long-term use (92.6%), use despite risk of falling (45.6%), combined use with other psychotropics (31.8%), and duplicate use (15.1%). Inappropriate prescribing was associated with depression (OR: 3.41) and insomnia (OR: 2.17).

Conclusion: The indicator-driven analysis of antipsychotic prescribing quality revealed a need for improvement, with the main prescribing problems relating to duration and combination of therapies. Risks/benefits of off-label use need to be evaluated more consciously at the start of therapy, and at periodic re-evaluations.

Inappropriate prescribing to the elderly is a serious problem and is one factor contributing to adverse drug reactions in this group. It is well-known that reliance on promotional literature for prescribing information leads to less appropriate prescribing. This study surveyed ads in two major Canadian medical journals which portrayed people who appeared to be over 65 years of age. The elderly were shown in just over 7 per cent of the ads. These ads did not appear to take into account the special drug needs of the elderly. Ads featuring the elderly could lead to inappropriate prescribing because of their pictorial content, their written content or a combination of both. Further research into this area is needed, specifically directed at factors which influence prescribing to the elderly. In the meantime physicians dealing with the elderly should critically analyse the message in drug advertisements and be aware of the risks of using them for therapeutic information.

This study utilized 1985 United States National Ambulatory Medical Care Survey data to explore the relationship between the drug prescribing phenomenon, measured by inappropriate prescribing and by prescription volume, and patient age. Inappropriate prescribing was relabelled potentially undesirable prescribing because limited medico-social patient information restricting circumstantial knowledge could result in an oversimplified and unduly critical judgment of prescribing. Categories of potentially undesirable prescribing were developed: 1) more than one drug in the same class; 2) drug classes not to be combined; 3) drugs serving sub-optimal treatment; and 4) drugs and diagnoses not to be combined. Of 67 different generic drugs representing 13 drug classes studied, 242 products were prescribed to the sample of 33,574 patients age 45+ years. Potentially undesirable prescribing was found to be a common problem regardless of type of medical practice and the sex of the patient: it is related to the age of the patient. The adverse effect of visiting a general practitioner is greater for older patients; and the adverse effect of attending a practice in a non-metropolitan area is larger for the older patients.