"Drug use without indication" in elderly hospitalized patients.

A major challenge in the management of hospitalized elderly patients is a critical examination of a patient's medicines with the objective of optimization of drug therapy, minimizing the number of drug-related problems, and reducing waste. These patients with complex care needs have multiple medical conditions, often receive a number of important drugs, and are at increased risk of adverse effects of drugs. Evidence suggests that adverse drug events due to inappropriate prescribing in this population are quite prevalent[12] and highly preventable. The present study aimed to optimize drug therapy in hospitalized elderly patients.

The present study was carried out in a university teaching general hospital in Eastern province of Saudi Arabia. A team comprising two clinical pharmacists and two geriatricians critically reviewed medications prescribed in fifty elderly patients who were admitted to a medical care unit. Following information was collected: age, weight, creatinine clearance and diagnosis of each patient. For each drug, the following information was collected: trade name, active ingredient(s), dose, frequency, route of administration, and duration of treatment as well as drug allergies. After reviewing medical records, the team critically evaluated each prescribed drug against the evidence-based guidelines for their potential inappropriateness in geriatrics. In case where pharmacist and geriatric specialist mutually agreed that alteration in the medication prescribed is deemed necessary, the prescribing physician was then contacted for possible modification in drug therapy.

The mean age of patients was 83 ± 6 years (SD; 28 male and 22 female). A total 332 of drugs were prescribed with an average 6.6 drugs per patient. In 120/332 (36%) drugs, a discontinuation was recommended (2.1 drugs on average per patient) Table 1. Of these 120 drugs, 86 (72%) drugs were used without indication, or recommended duration of treatment had been exceeded. Moreover, out of these 120 drugs, 34 (28%) were found to be potentially inappropriate medications in geriatrics according to Beers and STOPP criteria.

Table 1

Number of drugs categorized by the reason of inappropriate prescribing and therapeutic classes in which pharmacist-geriatric team suggested discontinuation of drug

	Discontinuation of drug recommended (n=120)	Discontinuation of drug accepted (n=97)
Drugs prescribed without valid medical indication	86 (72%)	100% (86/86)
Cardiovascular drugs: Antihypertensives, diuretics	20	20
Psychotropic drugs: Benzodiazepines, antidepressants, neuroleptics	17	17
Gastrointestinal drugs: proton pump inhibitor, antiemetics, antispasmodics with anticholinergic effects	18	18
Analgesics and anti-inflammatory medications: NSAIDs, opioids	13	13
Coagulation: platelet aggregation inhibitors	7	7
Iron, folic acid	11	11
Potentially inappropriate medications	34 (28%)	11 (32%)
Central nervous system medications [benzodiazepines with half long life, first generation anti-histaminics]	6	2
Cardiovascular medications (vasodilators)	4	2
Anticholinergics	9	4
Centrally acting antihypertensives	3	2
Urinary tract drugs: alpha-blockers, urinary antispasmodics, anticholinergics (e.g., oxybutynin)	12	1

NSAIDs: Nonsteroidal anti-inflammatory drugs

Interventions were made to discontinue a drug by the clinical pharmacists-geriatrician team after consultation with the prescribing physicians. The rate of acceptance for alteration in those drugs which were prescribed without a valid indication was 100% (86/86 drugs were stopped by the prescribing physician). Among 34 drugs which were found potentially inappropriate for geriatrics, 11 drugs (32%) were discontinued.

Our study demonstrates that the collaboration between clinician pharmacist-geriatrician and physician can reduce inappropriate drug use. In our study, we found that prescribing of potentially inappropriate medications in elderly patients was not frequent. Current literature mainly relates to optimization of drug therapy in geriatric patients who have been prescribed potentially inappropriate medications.[34] Many published pharmacoepidemiological studies reported higher prevalence of potentially inappropriate medication based on Beers, STOPP/START, or other modified criteria. However, in our study, medication-related problems due to “drug use without indication” were more frequent than problems due to prescribing of drugs which are potentially inappropriate for elderly patients.

Our study highlights and confirms the findings of previous studies[5] that for the optimal drug therapy in elderly patients it is desirable to enhance and systematize the collaboration between a clinical pharmacist-geriatrician team and the treating physicians in medical units.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.