A new study from the U.S. Agency for Healthcare Research and Quality (AHRQ) highlights the problem of inappropriate prescribing in elderly patients in the United States. The study also underscores the importance of safe use of prescription medications as a critical component of quality of care, and demonstrates the challenges involved in assessing safe use.

According to findings in today's Journal of the American Medical Association (JAMA), about one fifth of the approximately 32 million elderly Americans not living in nursing homes in 1996 used at least one or more of 33 prescription medicines considered potentially inappropriate. Nearly one million elderly used at least one of 11 medications which a panel of geriatric medicine and pharmacy experts advising the researchers agreed should always be avoided in the elderly. These 11 medications include long-acting benzodiazapines, sedative or hypnotic agents, long-acting oral hypoglycemics, analgesics, antiemetics and gastrointestinal antispasmodics.

AHRQ Director John M. Eisenberg, M.D., said, "This important research indicates that patient safety issues can occur outside hospitals, nursing homes, and institutional settings and among any patient population. This study highlights the need to develop evidence-based programs and ways to improve prescribing practices in the United States."

The study also suggests that elderly women and older people who are in poor health and who use more prescriptions are more likely than others to receive inappropriate drugs.

According to lead author, Chunliu Zhan, M.D., Ph.D., the actual extent of inappropriate medication prescribing may be much higher than the estimates because of the conservative criteria the researchers used and because of the rate of introduction of new pharmaceutical agents into the market. Furthermore, inappropriate medication use in the elderly is a component of the even larger problem of suboptimal prescribing, which includes under-use of effective medications, inappropriate dosing, inappropriate combination use of drugs, and other prescription errors.

The full list of 33 potentially inappropriate medications reflects the consensus of the expert panel. Not all physicians agree about the appropriateness of specific drugs for the elderly. This lack of consensus stems in part from the limited amount of evidence of risks and benefits for some medications because older patients are often excluded from drug clinical trials due to their age and other medical problems.

The estimates are the most recent to use population-based nationally representative survey data. The study was based on AHRQ Medical Expenditure Panel Survey data on a national sample of 2,455 community dwelling elderly persons aged 65 and older in 1996.