A retrospective evaluation of potentially inappropriate medication use in hospitalized elderly patients

Abstract

An estimated 30% of hospitalizations in the elderly may be linked to drug related problems. The Beers criteria are a list of potentially inappropriate medications (PIMs) generally considered unsafe to prescribe in the elderly. These criteria are useful in assessing quality and safety of prescribing in the elderly population.

Purpose: The purpose of this study is to evaluate PIM use, as defined by the Beers criteria, in elderly hospitalized patients. Setting: 760-bed tertiary care, teaching hospital.

Methods: This cross-sectional study evaluated hospitalized patients ≥ 65 years old, consecutively admitted to general medical floors, starting 4/1/06 until 100 patients were enrolled. Each patient’s home, discharge, and inpatient medication profiles were screened for PIMs. Actual usage and duration of therapy, source of prescription, potential justification for use, and pharmacy interventions regarding PIMs were also collected.

Results: Based on home medication lists, 32% of patients were taking ≥ 1 PIM prior to admission; rising to 56% during hospitalization; and declining to 36% at discharge. Of the 93 active hospital PIM orders, 62% were new orders and 38% were continued home medications; 85% were categorized as “high” risk; 8.6% were potentially justified; and the pharmacist intervened on 3 of the PIM orders.

Conclusion: The percentage of patients prescribed PIMs increased significantly during hospitalization, but returned to baseline at dismissal. Health care provider education regarding safe medication prescribing in elderly hospitalized patients, formulary changes, and alterations to preprinted orders may be needed.