Perilious Prescriptions

A Few Final Suggestions

For many reasons, patient compliance and adherence can be problematic in older patients.14 Patients often don’t admit not taking their medications as directed. If nonadherence is suspected, the care provider should consider the patient’s financial, cognitive, and functional status, as well as the patient’s beliefs about and understanding of the medications and disease. A simple regimen (such as once daily dosing) and a caregiver who is involved in overseeing medication management are helpful. Medication trays or drug calendars are handy tools. Many older folks may need the reassurance regarding safety that additional education or reinforcement can provide.

Regardless of the steps the physician takes to ensure safe prescribing for the elderly, provider-patient communication is of utmost importance. TH

Dr. Egger works in General Internal Medicine, Section Hospital Medicine, at the Mayo Clinic in Rochester, Minn.

References

1. Winterstein AG, Sauer BC, Hepler CD, et al. Preventable drug-related hospital admissions. Ann Pharmacother. 2002;36(7-8):1238-1248.
2. Kohn L, Corrigan J, Donaldson M, eds. To Err Is Human: Building a Safer Health System. Committee on Quality of Health Care in America, Institute of Medicine. Washington, D.C.: National Academies Press; 2000.
3. Bond CA, Raehl CL, Franke T. Medication errors in United States hospitals. Pharmacotherapy. 2001 Sep;21(9):1023-1036.
4. Goulding MR. Inappropriate medication prescribing for elderly ambulatory care patients. Arch Intern Med. 2004 Feb;164(3):305-312.
5. Zhan C, Sangl J, Bierman AS, et al. Potentially inappropriate medication use in the community-dwelling elderly: findings from the 1996 Medical Expenditure Panel Survey. JAMA. 2001 Dec 12;286(22):2823-2829.
6. Cooper JW. Probable adverse drug reactions in a rural geriatric nursing home population: a four-year study. J Am Geriatr Soc. 1996 Feb;44(2):194-197.
7. Hanlon JT, Artz MB, Pieper CF, et al. Inappropriate medication use among frail elderly inpatients. Ann Pharmacother. 2004 Jan;38(1):9-14.
8. Beard K. Adverse reactions as a cause of hospital admission in the aged. Drugs Aging. 1992 Jul-Aug;2(4):356-367.
9. Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA. 1998 Apr 15;279(15):1200-1205.
10. Beers MH, Ouslander JG, Rollingher I, et al. Explicit criteria for determining inappropriate medication use in nursing home residents. UCLA Division of Geriatric Medicine. Arch Intern Med. 1991 Sep;151(9):1825-1832.
11. Fick DM, Cooper JW, Wade WE, et al. Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med. 2003 Dec 8-22;163(22):2716-2724.
12. Aparasu RR, Mort JR. Inappropriate prescribing for the elderly: beers criteria-based review. Ann Pharmacother. 2000 Mar;34(3):338-346.
13. Hanlon JT, Schmader KE, Ruby CM, et al. Suboptimal prescribing in older inpatients and outpatients. J Am Geriatr Soc. 2001 Feb;49(2):200-209.
14. Moisan J, Gaudet M, Gregoire JP, et al. Non-compliance with drug treatment and reading difficulties with regard to prescription labelling among seniors. Gerontology. 2002 Jan-Feb;48(1):44-51.