Inappropriate prescribing for the elderly: Beers criteria-based review

OBJECTIVE: To review currently available literature applying the Beers criteria for inappropriate medication use in the elderly to prescribing practices in various settings. DATA SOURCE: Key words including inappropriate, Beers, medication, prescribing, elderly, geriatric, and criteria were used to search MEDLINE records from January 1992 to June 1999. DATA EXTRACTION: Eight relevant studies were found that applied the Beers criteria in various healthcare settings. DATA SYNTHESIS: Each study was examined for methodologic issues, criteria used, prevalence, nature and extent of inappropriate medication use, and factors associated with their use. Despite the methodologic differences, the review revealed some consistent patterns across healthcare settings. The review has shown that (1) most of the prevalence showed that between nearly one in four (23.5%) and one in seven (14.0) elderly patients recieved an inappropriate medication as defined by either the Beers list of 20 inappropriate or the Modified Beers list; (3) the majority of these patients recieved one inappropriate agent; and (4) longacting benzodiazepines, dipyridamole, propoxyphene, and amitriptyline were amoung the most frequently prescribed inappropriate medications. Univariate analyses indicated that women, patients >80 years, and Medicaid patients appeared to recieved more inappropriate mediations than others; however, multivariate analyses found that only a higher number of medications was consistently associated with inappropriate medication use. CONCLUSION: Inappropriate prescribing or use trends are noteworthy because they were observed despite methodologic differences. The finding can be instrumental in developing targeted interventions to influence to future precribing practices. More research is needed to address the national trends and healthcare impact of inappropriate drug use in the elderly.