Inappropriate prescribing in the elderly: a comparison of the Beers criteria and the improved prescribing in the elderly tool (IPET) in acutely ill elderly hospitalized patients.
AffiliationDepartment of Geriatric Medicine, Cork University Hospital, Wilton, Cork,, Ireland. firstname.lastname@example.org
Aged, 80 and over
Medication Errors/*statistics & numerical data
Physician's Practice Patterns
MetadataShow full item record
CitationJ Clin Pharm Ther. 2006 Dec;31(6):617-26.
JournalJournal of clinical pharmacy and therapeutics
AbstractBACKGROUND: In appropriate prescribing is a significant and persistent problem in elderly people, both in hospital and the community and has been described in several countries in Europe and also the USA. The problem of inappropriate prescribing has not been quantified in the Republic of Ireland. The most commonly used criteria for the identification of inappropriate prescribing are the Beers' criteria [both independent of diagnosis (ID) and considering diagnosis (CD) - 2003 version]. The Beers' criteria ID includes 48 different categories of either single medications or multiple medications of a similar class identified as inappropriate prescriptions and the Beers' criteria CD contains 19 different categories containing possible drug-disease interactions. A second tool, the improved prescribing in the elderly tool (IPET) has also been validated and used in hospital and community studies and has 14 categories of either explicitly contraindicated medications or possible drug-disease interactions. OBJECTIVES: The primary aim of the study is to measure the incidence of inappropriate prescribing among older community-dwelling individuals presenting to an acute hospital in the Republic of Ireland. A secondary aim of this study was also therefore to compare the efficacy of the above two tools in identifying inappropriate prescribing. METHODS: A prospective, consecutive observational cohort study was carried out over a 4-month period. The setting was an urban-based university hospital acute geriatric medicine assessment unit. Subjects in this study (n = 350) were consecutively screened on admission to hospital (mean age = 80.3 +/- 6.1 years) and all patients had both Beers' criteria ID and CD and IPET applied to their list of prescription drugs on admission, cross-referenced with their list of current active medical diagnosis. RESULTS: The results of the study identified a high rate of inappropriate prescribing among this population of community-dwelling subjects. The total number of inappropriate prescriptions identified using the Beers' criteria (ID) was 148 affecting 121 patients. The Beers' criteria (CD) identified 69 inappropriate prescriptions in 60 patients and the IPET identified 112 inappropriate prescriptions in 78 patients. The Beers criteria (ID and CD combined) identified at least one inappropriate prescription in 34% of subjects and the IPET identified one in at least 22% of subjects. CONCLUSIONS: This study identifies high rates of use of inappropriate medications in community-dwelling elderly presenting with acute illness to hospital. These are comparable with inappropriate prescribing rates identified in previous studies. The revised Beers' criteria (2003) identified more inappropriate prescriptions than the IPET in this population of elders.
- Appropriate prescribing in the elderly: an investigation of two screening tools, Beers criteria considering diagnosis and independent of diagnosis and improved prescribing in the elderly tool to identify inappropriate use of medicines in the elderly in primary care in Ireland.
- Authors: Ryan C, O'Mahony D, Kennedy J, Weedle P, Barry P, Gallagher P, Byrne S
- Issue date: 2009 Aug
- Inappropriate prescribing in an acutely ill population of elderly patients as determined by Beers' Criteria.
- Authors: Gallagher PF, Barry PJ, Ryan C, Hartigan I, O'Mahony D
- Issue date: 2008 Jan
- Potentially inappropriate prescribing in an Irish elderly population in primary care.
- Authors: Ryan C, O'Mahony D, Kennedy J, Weedle P, Byrne S
- Issue date: 2009 Dec
- Inappropriate prescribing in the older population: need for new criteria.
- Authors: O'Mahony D, Gallagher PF
- Issue date: 2008 Mar
- Using explicit criteria to evaluate the quality of prescribing in elderly Italian outpatients: a cohort study.
- Authors: Maio V, Del Canale S, Abouzaid S, GAP Investigators.
- Issue date: 2010 Apr