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Explicit Criteria for Determining Potentially Inappropriate Medication Use by the Elderly: An Update

Explicit Criteria for Determining Potentially Inappropriate Medication Use by the Elderly: An Update Abstract This study updates and expands explicit criteria defining potentially inappropriate medication use by the elderly. Additional goals were to address whether adverse outcomes were likely to be clinically severe and to incorporate clinical information on diagnoses when available. These criteria are meant to serve epidemiological studies, drug utilization review systems, health care providers, and educational efforts. Consensus from a panel of 6 nationally recognized experts on the appropriate use of medication in the elderly was sought. The expert panel agreed on the validity of 28 criteria describing the potentially inappropriate use of medication by general populations of the elderly as well as 35 criteria defining potentially inappropriate medication use in older persons known to have any of 15 common medical conditions. Updated, expanded, and more generally applicable criteria are now available to help identify inappropriate use of medications in elderly populations. These criteria define medications that should generally be avoided in the ambulatory elderly, doses or frequencies of administrations that should generally not be exceeded, and medications that should be avoided in older persons known to have any of several common conditions. Arch Intern Med. 1997;157:1531-1536 References 1. Beers MH, Ouslander JG, Rollingher I, Brooks J, Reuben D, Beck JC. Explicit criteria for determining inappropriate medication use in nursing homes . Arch Intern Med. 1991;151:1825-1832.Crossref 2. Beers MH, Ouslander JG, Fingold SF, et al. Inappropriate medication prescribing in skillednursing facilities . Ann Intern Med. 1992;117:684-689.Crossref 3. Beers MH, Fingold SF, Ouslander JG, Morgenstern H, Reuben D, Beck JC. Characteristics and quality of prescribing by doctors practicing in nursing homes . J Am Geriatr Soc. 1993;41:802-807. 4. Stuck A, Beers MH, Steiner A, et al. Inappropriate medication use in the ambulatory elderly . Arch Intern Med. 1994;154:2195-2200.Crossref 5. Anderson GM, Beers MH, Kerluke K. Physician characteristics associated with inappropriate drug selection in the elderly . J Evaluat Clin Pract . In press. 6. Wilcox SM, Himmelstein DU, Woolhandler S. Inappropriate drug prescribing for the community-dwelling elderly . JAMA. 1994;272:292-296.Crossref 7. Beers MH. Defining inappropriate medication use in the elderly . In: Rowe JW, Ahronheim JC, eds. Annual Review of Geriatrics and Gerontology . New York, NY: Springer Publishing Co Inc; 1992:29-40. 8. Brook BH, Kamberg C, Mayer-Oakes A, Beers MH, Raube K, Steiner A. Appropriateness of acute medical care for the elderly . Health Policy. 1990;14:225-242.Crossref 9. Avanzini F, Alli C, Bettelli G, et al. Antihypertensive efficacy and tolerability of different drug regimens in isolated systolic hypertension in the elderly . Eur Heart J. 1994;15:206-212.Crossref 10. Burke V, Beilin LJ, German R, et al. Postural fall in blood pressure in the elderly in relation to drug treatment and other lifestyle factors . QJM. 1992; 84:583-591. 11. Avorn J, Bohn RL, Mogun H, et al. Neuroleptic drug exposure and treatment of parkinsonism in the elderly: a case-control study . Am J Med. 1995;99:48-54.Crossref 12. Griffin MR, Piper JM, Daugherty JR, Snowden M, Ray WA. Nonsteroidal anti-inflammatory drug use and increased risk for peptic ulcer disease in elderly persons . Ann Intern Med. 1991;114:257-263.Crossref 13. O'Malley K, Cox JP, O'Brien E. Choice of drug treatment for elderly hypertensive patients . Am J Med. 1991;90:27S-33S.Crossref 14. Weinblatt ME. Nonsteroidal anti-inflammatory drug toxicity: increased risk in the elderly . Scand J Rheumatol. 1991;91( (suppl) ):9-17.Crossref 15. Chutka DS, Evans JM, Fleming KC, Mikkelson KG. Symposium on geriatrics, I: drug prescribing for elderly patients . Mayo Clin Proc. 1995;70:685-693.Crossref 16. Freeman C. Drug treatment of insomnia in the elderly . Conn Med. 1992;56:35-37. 17. Ganzini L, Millar SB, Walsh JR. Drug-induced mania in the elderly . Drugs Aging. 1993;3:428-435.Crossref 18. Ganzini L, Walsh JR, Millar SB. Drug-induced depression in the aged: what can be done? Drugs Aging. 1993;3:147-158.Crossref 19. Gershanik OS. Drug-induced parkinsonism in the aged: recognition and prevention . Drugs Aging. 1994;5:122-127.Crossref 20. Gibian T. Rational drug therapy in the elderly or how not to poison your elderly patients . Aust Fam Physician. 1992;21:1755-1760. 21. Katz IR. Drug treatment of depression in the frail elderly: discussion of the NIH Consensus Development Conference on the diagnosis and treatment of depression in late life . Psychopharmacol Bull. 1993;29:101-108. 22. Lindley CM, Tully MP, Paramsothy V, Tallis RC. Inappropriate medication is a major cause of adverse drug reactions in elderly patients . Age Ageing. 1992;21:294-300.Crossref 23. Schneider JK, Mion LC, Frengley JD. Adverse drug reactions in an elderly outpatient population . Am J Hosp Pharm. 1992;49:90-96. 24. Smith M, Buckwalter KC. Medication management, antidepressant drugs, and the elderly: an overview . J Psychosoc Nurs Mental Health Serv. 1992;30:30-36. 25. Volz HP, Moller HJ. Antidepressant drug therapy in the elderly: a critical review of the controlled clinical trials conducted since 1980 . Pharmacopsychiatry . 1994;27:93-100.Crossref 26. Williams SG, DiPalma JA. Medication-induced digestive system injury in the elderly . Geriatr Nurs. 1992;13:39-42.Crossref 27. Williams L, Lowenthal DT. Drug therapy in the elderly . South Med J. 1992;85:127-131.Crossref 28. Matell MS, Jacoby J. Is there an optimal number of alternatives for Likert scale items? I: reliability and validity . Educ Psychol Measure. 1971;31:657-674.Crossref 29. Dalkey NC. Delphi: P-3704 RAND . Santa Monica, Calif: RAND; 1967. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Explicit Criteria for Determining Potentially Inappropriate Medication Use by the Elderly: An Update

Archives of Internal Medicine , Volume 157 (14) – Jul 28, 1997

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Publisher
American Medical Association
Copyright
Copyright © 1997 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1997.00440350031003
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See Article on Publisher Site

Abstract

Abstract This study updates and expands explicit criteria defining potentially inappropriate medication use by the elderly. Additional goals were to address whether adverse outcomes were likely to be clinically severe and to incorporate clinical information on diagnoses when available. These criteria are meant to serve epidemiological studies, drug utilization review systems, health care providers, and educational efforts. Consensus from a panel of 6 nationally recognized experts on the appropriate use of medication in the elderly was sought. The expert panel agreed on the validity of 28 criteria describing the potentially inappropriate use of medication by general populations of the elderly as well as 35 criteria defining potentially inappropriate medication use in older persons known to have any of 15 common medical conditions. Updated, expanded, and more generally applicable criteria are now available to help identify inappropriate use of medications in elderly populations. These criteria define medications that should generally be avoided in the ambulatory elderly, doses or frequencies of administrations that should generally not be exceeded, and medications that should be avoided in older persons known to have any of several common conditions. Arch Intern Med. 1997;157:1531-1536 References 1. Beers MH, Ouslander JG, Rollingher I, Brooks J, Reuben D, Beck JC. Explicit criteria for determining inappropriate medication use in nursing homes . Arch Intern Med. 1991;151:1825-1832.Crossref 2. Beers MH, Ouslander JG, Fingold SF, et al. Inappropriate medication prescribing in skillednursing facilities . Ann Intern Med. 1992;117:684-689.Crossref 3. Beers MH, Fingold SF, Ouslander JG, Morgenstern H, Reuben D, Beck JC. Characteristics and quality of prescribing by doctors practicing in nursing homes . J Am Geriatr Soc. 1993;41:802-807. 4. Stuck A, Beers MH, Steiner A, et al. Inappropriate medication use in the ambulatory elderly . Arch Intern Med. 1994;154:2195-2200.Crossref 5. Anderson GM, Beers MH, Kerluke K. Physician characteristics associated with inappropriate drug selection in the elderly . J Evaluat Clin Pract . In press. 6. Wilcox SM, Himmelstein DU, Woolhandler S. Inappropriate drug prescribing for the community-dwelling elderly . JAMA. 1994;272:292-296.Crossref 7. Beers MH. Defining inappropriate medication use in the elderly . In: Rowe JW, Ahronheim JC, eds. Annual Review of Geriatrics and Gerontology . New York, NY: Springer Publishing Co Inc; 1992:29-40. 8. Brook BH, Kamberg C, Mayer-Oakes A, Beers MH, Raube K, Steiner A. Appropriateness of acute medical care for the elderly . Health Policy. 1990;14:225-242.Crossref 9. Avanzini F, Alli C, Bettelli G, et al. Antihypertensive efficacy and tolerability of different drug regimens in isolated systolic hypertension in the elderly . Eur Heart J. 1994;15:206-212.Crossref 10. Burke V, Beilin LJ, German R, et al. Postural fall in blood pressure in the elderly in relation to drug treatment and other lifestyle factors . QJM. 1992; 84:583-591. 11. Avorn J, Bohn RL, Mogun H, et al. Neuroleptic drug exposure and treatment of parkinsonism in the elderly: a case-control study . Am J Med. 1995;99:48-54.Crossref 12. Griffin MR, Piper JM, Daugherty JR, Snowden M, Ray WA. Nonsteroidal anti-inflammatory drug use and increased risk for peptic ulcer disease in elderly persons . Ann Intern Med. 1991;114:257-263.Crossref 13. O'Malley K, Cox JP, O'Brien E. Choice of drug treatment for elderly hypertensive patients . Am J Med. 1991;90:27S-33S.Crossref 14. Weinblatt ME. Nonsteroidal anti-inflammatory drug toxicity: increased risk in the elderly . Scand J Rheumatol. 1991;91( (suppl) ):9-17.Crossref 15. Chutka DS, Evans JM, Fleming KC, Mikkelson KG. Symposium on geriatrics, I: drug prescribing for elderly patients . Mayo Clin Proc. 1995;70:685-693.Crossref 16. Freeman C. Drug treatment of insomnia in the elderly . Conn Med. 1992;56:35-37. 17. Ganzini L, Millar SB, Walsh JR. Drug-induced mania in the elderly . Drugs Aging. 1993;3:428-435.Crossref 18. Ganzini L, Walsh JR, Millar SB. Drug-induced depression in the aged: what can be done? Drugs Aging. 1993;3:147-158.Crossref 19. Gershanik OS. Drug-induced parkinsonism in the aged: recognition and prevention . Drugs Aging. 1994;5:122-127.Crossref 20. Gibian T. Rational drug therapy in the elderly or how not to poison your elderly patients . Aust Fam Physician. 1992;21:1755-1760. 21. Katz IR. Drug treatment of depression in the frail elderly: discussion of the NIH Consensus Development Conference on the diagnosis and treatment of depression in late life . Psychopharmacol Bull. 1993;29:101-108. 22. Lindley CM, Tully MP, Paramsothy V, Tallis RC. Inappropriate medication is a major cause of adverse drug reactions in elderly patients . Age Ageing. 1992;21:294-300.Crossref 23. Schneider JK, Mion LC, Frengley JD. Adverse drug reactions in an elderly outpatient population . Am J Hosp Pharm. 1992;49:90-96. 24. Smith M, Buckwalter KC. Medication management, antidepressant drugs, and the elderly: an overview . J Psychosoc Nurs Mental Health Serv. 1992;30:30-36. 25. Volz HP, Moller HJ. Antidepressant drug therapy in the elderly: a critical review of the controlled clinical trials conducted since 1980 . Pharmacopsychiatry . 1994;27:93-100.Crossref 26. Williams SG, DiPalma JA. Medication-induced digestive system injury in the elderly . Geriatr Nurs. 1992;13:39-42.Crossref 27. Williams L, Lowenthal DT. Drug therapy in the elderly . South Med J. 1992;85:127-131.Crossref 28. Matell MS, Jacoby J. Is there an optimal number of alternatives for Likert scale items? I: reliability and validity . Educ Psychol Measure. 1971;31:657-674.Crossref 29. Dalkey NC. Delphi: P-3704 RAND . Santa Monica, Calif: RAND; 1967.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Jul 28, 1997

References