The Pharmaceutical Journal
Vol 270 No 7241 p394
22 March 2003

This article
Reprint
Photocopy

News summary

Related websites
BMJ abstract (more)

Poor prescribing for the elderly found

Clinical care for the elderly in the United Kingdom has been found wanting by primary care researchers (BMJ 2003;326:580).

A lack of beneficial drugs, the prescribing of too many inappropriate medicines and poor monitoring of chronic disease were key deficiencies they identified.

The study, based in three general practices in Bristol, looked at specific prescribing standards in heart disease, diabetes and other areas, such as 'flu vaccination and the use of antipsychotics in people over 65 years. It compared the care given to nursing home residents with those living in their own homes.

The authors say that elderly people are receiving "inadequate care", with those in nursing homes more likely to receive inappropriate or unnecessary drugs and less likely to have chronic disease well monitored. Around a quarter of the population had no record of receiving or being offered a 'flu vaccination. Only 38 per cent of patients who should have been prescribed beta blockers after myocardial infarction were taking these drugs, and only 61 per cent of suitable candidates were taking aspirin for coronary heart disease.

Nursing home residents were more likely to be prescribed antipsychotics — 28 per cent compared with 11 per cent of those living at home. They were also more likely to be using laxatives (39 per cent versus 16 per cent). The study found 10 patients on thioridazine, all of whom were nursing home residents.

Although most patients living at home had had their blood pressure monitored within the past two years for heart disease or in the past year for diabetes, in nursing homes the figures were 74 per cent and 62 per cent, respectively. "These findings are particularly topical in the light of Government policy that aims to improve health care for older people," the authors say.

They call for suitable education and interventions for primary care staff to improve care.

"More sophisticated models of optimal prescribing are needed in elderly people, with due regard to overuse and underuse of drugs," they conclude.

Professor Tom Fahey, University of Dundee, lead author of the project, told The Journal that pharmacists were a useful resource in medication review, and would be particularly helpful with regard to prescribing for the elderly in nursing homes. He added that pharmacist involvement has been shown to improve the cost effectiveness of repeat prescribing, which is common in older patients.