The Pharmaceutical Journal
Vol 269 No 7211 p204
17 August 2002

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Archives of Internal Medicine (archinte.ama-assn.org)

Inappropriate drugs prescribed for many elderly patients living at home

Many elderly patients living at home are taking medicines that are inappropriate for them, according to new research (Archives of Internal Medicine 2002;162:1707).

Finnish researchers found that about a third of elderly patients taking beta-blockers had conditions, in addition to concomitant heart disease, where use of these drugs is considered inappropriate. They found that 37.9 per cent of those with peripheral vascular disease were taking beta-blockers, which can increase leg pain in this instance.

Meanwhile, 32.5 per cent of those with diabetes taking oral hypoglycaemics or insulin and 27.2 per cent of patients with chronic obstructive pulmonary disease (COPD) were also taking beta-blockers, which can mask symptoms of low blood sugar and affect breathing. In addition, the researchers found 19.3 per cent of COPD patients were using sedatives, which can suppress breathing.

The researchers surveyed over 3,000 urban residents in Helsinki, Finland, aged 75–95 years, to determine the prevalence of drug use considered inappropriate for 15 common medical conditions according to recommendations made by an American expert group in 1997. They also assessed the general prevalence of drug use considered to be inappropriate in the elderly, but found this was low compared with that found in previous studies. Of those responding to the survey, 12.5, 1.3 and 0.2 per cent were regularly taking one, two or three inappropriate drugs, respectively. The antiplatelet drug dipyridamole was the most prevalent inappropriate drug, occurring in 3.6 per cent of cases, followed by long-acting benzodiazepines, in 2.6 per cent of cases.

In an accompanying editorial, Dr Jerry Gurwitz from Massachusetts University Medical School suggests that the apparently low level of inappropriate drug use found in this study may be due to the fact that many of the drugs included in the American expert group's 1997 list are no longer used or no longer available in Finland. He suggests the prevalence of inappropriate medication among the elderly could be higher than that found by this study and that enhanced collaboration between those who prescribe drugs and those who know medications best — clinical pharmacists — would improve the quality of medicine use in these patients.