Potentially inappropriate prescribing including under-use amongst older patients with cognitive or psychiatric co-morbidities

Lang, Pierre Olivier; Hasso, Yasmine; Drame, Moustapha; Vogt-Ferrier, Nicole Barbara; Prudent, Max; Gold, Gabriel; Michel, Jean-Pierre

doi:10.1093/ageing/afq031

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Title		Potentially inappropriate prescribing including under-use amongst older patients with cognitive or psychiatric co-morbidities
Authors		Lang, Pierre Olivier Hasso, Yasmine Drame, Moustapha Vogt-Ferrier, Nicole Barbara Prudent, Max Gold, Gabriel Michel, Jean-Pierre
Published in		Age and ageing. 2010, vol. 39, no. 3, p. 373-381
Collection		Open Access - Licence nationale Oxford University Press
Abstract		OBJECTIVE: the study aimed to determine the prevalence of and risk factors for inappropriate prescribing (IP) and prescribing omission (PO) in elderly with mental co-morbidities. PARTICIPANTS: One hundred fifty consecutive inpatients with mental co-morbidities hospitalised for acute medical illness (mean age 80 +/- 9, 70% of women) were considered for the study. MEASUREMENTS: IP and PO were prospectively identified according to STOPP/START criteria at hospital admission. RESULTS: over 95% were taking ≥ 1 medication (median = 7) which amounted to 1,137 prescriptions. The prevalence of IP was 77% and PO was 65%. The most frequent encountered IP concerned drugs adversely affecting fallers (25%) and antiaggregants therapy without atherosclerosis (14%). PO concerned antidepressants with moderate/severe depression (20%) and calcium-vitamin D supplementation (18%). Independent predictors for IP were increased number of concomitant drugs (odds ratio [OR] 1.54, 95% confidence interval [CI] 1.13-1.89), being cognitively impaired (OR 1.83, 95% CI 1.55-2.24), and having fallen in the preceding 3 months (OR 2.03, 95% CI 1.52-2.61) or hospitalised in the preceding year (OR 1.09, 95% CI 1.02-1.23). Concerning PO, psychiatric disorder (OR 1.64, 95% CI 1.42-2.01) and increase level of co-morbidities (OR 1.79, 95% CI 1.48-1.99) were identified. Living in an institutional setting was a predictive maker for both IP (OR 1.45, 95% CI 1.27-1.74) and PO (OR 1.67, 95% CI 1.32-1.91). CONCLUSION: IP and PO were highly prevalent raising the need of a greater health literacy concerning geriatric conditions in non-geriatrician practitioners who care elderly as well as in the community, in hospital and institutional settings for improving quality and safety in prescribing medication.
Keywords		Aged — Aged, 80 and over — Comorbidity — Drug Prescriptions/standards/statistics & numerical data — Female — Humans — Inpatients — Male — Medication Errors/statistics & numerical data — Mental Disorders/drug therapy — Physician's Practice Patterns/standards/statistics & numerical data — Prevalence — Prospective Studies — Psychotropic Drugs/*therapeutic use — Risk Factors
Identifiers		DOI: 10.1093/ageing/afq031 PMID: 20378571
Full text		Article (Published version) - Free access Other version: http://ageing.oxfordjournals.org/content/39/3/373.full.pdf
Structures		Faculté de médecine / Section de médecine clinique / Département de réadaptation et gériatrie
Research groups		Démence du sujet âgé, troubles cognitifs, la symptomatologie cognitive (577) Groupe Desmeules Jules (pharmacologie/toxicologie) (567)
Citation (ISO format)		LANG, Pierre Olivier et al. Potentially inappropriate prescribing including under-use amongst older patients with cognitive or psychiatric co-morbidities. In: Age and ageing, 2010, vol. 39, n° 3, p. 373-381. doi: 10.1093/ageing/afq031 https://archive-ouverte.unige.ch/unige:21070