Inappropriate Medication Prescribing for the Elderly by Office-Based Physicians

1997 ◽  
Vol 31 (7-8) ◽  
pp. 823-829 ◽  
Author(s):  
Rajender R. Aparasu ◽  
Shana E. Fliginger
Keyword(s):  
Inappropriate Medication ◽  
Geriatric Medicine ◽  
The Elderly ◽  
Sample Survey ◽  
Office Visits ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Probability Sample ◽  
National Probability Sample ◽  
Inappropriate Medications

OBJECTIVE: To estimate the prevalence of inappropriate medications prescribed by office-based physicians for patients 65 years or older. DESIGN: A nationwide cross-sectional survey of office visits by the elderly. SETTING: The National Ambulatory Medical Care Survey (NAMCS) 1992, a national probability sample survey of office visits by ambulatory patients within the continental US. SUBJECTS: A national probability sample of patients 65 years or older visiting office-based physicians. National estimates are based on the National Center for Health Statistics weighting procedure for the NAMCS sample. MAIN OUTCOME MEASURES: Prevalence of 20 inappropriate medications that should be entirely avoided in the elderly, using criteria developed by a panel of national experts in geriatric medicine and geriatric pharmacology. RESULTS: In the US during 1992, an estimated 8.47 million (95% CI 7.66 million to 9.28 million) office visits by the elderly indicated prescribing of at least 1 of the 20 inappropriate medications. Approximately 7.75 million (95% CI 6.98 million to 8.52 million) visits by the elderly involved 1 inappropriate medication and 0.72 million (95% CI 0.51 million to 0.93 million) visits included 2 inappropriate medications. According to the NAMCS, office-based physicians prescribed at least 1 inappropriate medication to 7.58% of the elderly who received prescriptions. The most frequently prescribed inappropriate medications were propoxyphene, amitriptyline, dipyridamole, diazepam, and chlorpropamide. Elderly patients rarely received prescriptions from office-based physicians for drugs such as secobarbital, isoxsuprine, trimethobenzamide, and carisoprodol. Furthermore, office-based physicians did not prescribe cyclandelate, pentobarbital, or phenylbutazone for the elderly. CONCLUSIONS: The prescribing of inappropriate medications by office-based physicians raises concerns regarding the quality of care for the elderly in ambulatory settings. The crux of improving patient care in ambulatory settings rests with collaborative efforts between physicians and pharmacists.

scholarly journals The Status of Potentially Inappropriate Medication Prescription by General Physicians for The Elderly in Tabriz (Iran) According to Beers Criteria

Salmand ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. 274-287
Author(s):  
Tahereh Eteraf Oskouei ◽  
◽  
Elaheh Vatankhah ◽  
Moslem Najafi ◽  
◽  
...  
Keyword(s):  
Inappropriate Medication ◽  
Geriatric Medicine ◽  
The Elderly ◽  
Beers Criteria ◽  
Potentially Inappropriate Medications ◽  
Medical Council ◽  
Cross Sectional ◽  
General Physicians ◽  
The Status ◽  
The Mean

Objectives: Prescribing medication for the elderly is an important health issue. This study aimed to investigate the status of Potentially Inappropriate Medications (PIMs) prescription for the elderly by general physicians in Tabriz, Iran. Methods & Materials: This descriptive cross-sectional study was conducted in 2019 on the prescriptions of general physicians for the elderly in Tabriz, Iran. After initial screening of 16842 prescriptions belonged to two insurance systems (social security insurance and health insurance), 1500 prescriptions were selected. The Beers criteria 2019 was used to assess PIM prescription status and their alternatives were suggested if needed. Data were expressed as Mean±Standard Deviation (SD) and No. (%), and analyzed in SPSS v. 21 software. The Mann-Whitney U test was used to examine the differences in the study factors between the prescriptions related to two insurance systems. The relationship between patients’ age and PIM prescription was examined using Spearman correlation test. Results: The Mean±SD number of drugs in each prescription was 3.93±1.5 and the Mean±SD number of prescribed PIMs was 0.74±0.8. Polypharmacy was observed in 32.6% of the prescriptions, and 53.9% had at least one PIM. Non-steroidal anti-inflammatory drugs, antihistamines and benzodiazepines were the most PIM groups (45.6, 10.9 and 10.6%, respectively). The most common prescribed PIMs were Adult cold, Diclofenac, Glibenclamide, Ketorolac and Diphenhydramine. Number of PIMs in each prescription did were not statistically different between the prescriptions related to two insurance systems (P=0.343). Moreover, patients’ age and gender had no significant relationship with PIM prescription (P=0.312 and P=0.660, respectively). Conclusion: About 54% of the prescriptions issued by general physicians for the elderly in Tabriz contain PIMs, and polypharmacy is present in about one third of the prescriptions. In order to improve this condition, it is necessary to hold appropriate training and continuous retraining courses in geriatric medicine for general physicians. Supervisions by the Iranian Ministry of Health and Iranian Medical Council can also play an important role in improving the current situation.

Ambulatory Care: Medication Use Characteristics in an Ambulatory Elderly Population in Taiwan

1997 ◽  
Vol 31 (3) ◽  
pp. 308-314 ◽  
Author(s):  
Rou-Yee Chen Hsu ◽  
Min-Shung Lin ◽  
Mei-Huei Chou ◽  
Ming-Fang Lin
Keyword(s):  
Hormone Replacement ◽  
The Elderly ◽  
Nonsteroidal Antiinflammatory Drugs ◽  
Prescribing Patterns ◽  
Cross Sectional Survey ◽  
Antiinflammatory Drugs ◽  
Cross Sectional ◽  
Therapeutic Category ◽  
Prescribing Trends ◽  
Drug Expenditures

Objective To compare prescribing patterns between the elderly and nonelderly in 1994, to disclose prescribing trends in the elderly between 1992 and 1994, to explore whether drug utilization is in agreement with disease prevalence, and to identify suboptimal prescribing by drug category for ambulatory elderly patients. Design Cross-sectional survey at two separate time intervals. Setting All public group practice centers (GPCs) in Taiwan. Patients Ambulatory adults who visited GPCs during 1 random week. Those 65 years or over were classified as the elderly group, and those 20-64 years were the nonelderly group. Main Outcome Measures Mean diagnosis, drug use, and expenditure; frequency of diagnosis; and prescribing by therapeutic category. Results Data on 30 777 elderly and 38 184 nonelderly patients were collected in 1994. There was widespread use of antacids. Compared with nonelderly adults, the elderly were diagnosed with more diseases (1.3 vs. 1.2, respectively; p < 0.01), received more medications (4.7 vs. 4.1, respectively; p < 0.01), and had higher drug expenditures (5.4 vs. 4.6, respectively; p < 0.01). Chronic illness was more prevalent in the elderly, which accounted for the extensive use of cardiovascular drugs (32.1%), nonsteroidal antiinflammatory drugs (25.9%), and anxiolytics (15.9%). The upward trend in the elderly from 1992 to 1994 with hypertension (18.6% vs. 20.0%) or diabetes (9.2% vs. 10.9%) did not result in more cases of cerebrovascular disease (7.1% vs. 4.9%). There was a substantial increase in use of antispasmodic and gastroprokinetic agents (4.5% to 10.7%); the use of antacids decreased (73.6% to 63.4%) in the elderly. Conclusions Compared with the prevalence of disease, there was extensive nonspecific use of anxiolytics and antacids. However, lessened use of antidepressants and postmenopausal hormone replacement may have an impact on morbidity and mortality and deserves particular attention.

Association of socioeconomic and lifestyle factors with chronic non-communicable diseases and multimorbidity among the elderly in rural southwest China

2019 ◽  
Vol 42 (2) ◽  
pp. 239-246 ◽  
Author(s):  
Xiao Li ◽  
Le Cai ◽  
Wen-long Cui ◽  
Xu-ming Wang ◽  
Hui-fang Li ◽  
...  
Keyword(s):  
Older Adults ◽  
Low Income ◽  
Southwest China ◽  
Communicable Disease ◽  
Fasting Blood Glucose ◽  
The Elderly ◽  
Lifestyle Factors ◽  
Medical Services ◽  
Cross Sectional Survey ◽  
Cross Sectional

Abstract Background This study estimates the prevalence of five chronic non-communicable disease (NCDs) (hypertension, diabetes, CHD, COPD and stroke) and its multimorbidity, and examines the relationship between SES and lifestyle factors and multimorbidity among older adults in rural southwest China. Methods A cross-sectional survey of 4833 consenting adults aged ≥60 years was conducted in 2017. Data on the demographics, smoking, drinking, height, weight, blood pressure and fasting blood glucose were collected. Results Among the participants, the overall prevalence of hypertension, diabetes, stroke, COPD and CHD was 50.6, 10.2, 6.4, 5.4 and 5.5%, respectively, and of multimorbidity was 16.1%. Females had a higher prevalence of hypertension, diabetes and multimorbidity of chronic NCDs, but a lower prevalence of COPD than males (P &lt; 0.05). Older adults with good household assets and access to medical services were less likely to experience multimorbidity, whereas obese and centrally obese participants, current smokers, current drinkers and those with a family history of chronic NCDs had a greater probability of multimorbidity. Conclusions The findings suggest that effective strategies for prevention and control of chronic NCDs and its multimorbidity are urgently needed, especially for low-income, elderly, ethnic minority adults with poor access to medical services.

scholarly journals Racial inequalities in the socioeconomic, demographic and health conditions of elderly from Maranhão State, Legal Amazon, Brazil: a population-based study

2014 ◽  
Vol 44 (3) ◽  
pp. 335-344 ◽  
Author(s):  
Bruno Luciano Carneiro Alves de Oliveira ◽  
Alécia Maria da Silva ◽  
Raimundo Antonio da Silva ◽  
Erika Barbara Abreu Fonseca Thomaz
Keyword(s):  
Social Role ◽  
Health Indicators ◽  
The Elderly ◽  
Population Based ◽  
Sample Survey ◽  
Health Conditions ◽  
Activity Levels ◽  
Racial Groups ◽  
Cross Sectional ◽  
Racial Inequalities

Aging with quality of life does not occur equally among the racial groups of Brazilian elderly, and few studies have analyzed this issue in the states of the Brazilian Legal Amazon. The objective of this study was to investigate racial inequalities in the socioeconomic, demographic and health conditions of elderly residents of Maranhão state, Brazil. The present work is a cross-sectional study of 450 elders aged 60 years or older included in the 2008 National Household Sample Survey. The prevalence of socioeconomic, demographic, health and habit indicators and of risk factors were estimated in white, brown and black racial categories that were self-reported by the survey participants. The chi-square test was used for comparisons (a=5%). The majority of the elderly respondents identified themselves as brown (66.4%) or white (23.3%). There were significant socioeconomic, demographic, habit and lifestyle differences among the racial groups. Most of the black and brown elderly lived alone, reported lower educational levels and were in the lowest quintile for income. These respondents were also highly dependent on the Unified Health System (Sistema Único de Saúde - SUS), exhibited low rates of screening mammograms and lower physical activity levels and had a greater proportion of smokers. However, there was no difference in the prevalence of health indicators or in the proportion of elderly by gender, age, social role in the family or the urban-rural location of the household. These results indicate the presence of racial inequalities in the socioeconomic and demographic status and in the practice of healthy habits and lifestyles among elderly from Maranhão, but suggest equity in health status. The results also suggest the complexity and challenges of interlinking race with socioeconomic aspects, and the findings reinforce the need for the implementation of public policies for these population groups.

Population-based cardiovascular risk factors in the elderly in Turkey: a cross-sectional survey

Open Medicine ◽  
2008 ◽  
Vol 3 (2) ◽  
pp. 173-178 ◽  
Author(s):  
Adem Ozkara ◽  
Faruk Turgut ◽  
Mehmet Kanbay ◽  
Yusuf Selcoki ◽  
Ali Akcay
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Coronary Artery ◽  
Cardiovascular Risk Factors ◽  
Past History ◽  
Public Health Problem ◽  
The Elderly ◽  
Cross Sectional Survey ◽  
Important Public Health Problem ◽  
Cross Sectional

AbstractHypertension, diabetes, hyperlipidaemia, obesity and smoking are known to be the most important modifiable risk factors for cardiovascular disease (CVD). Because the elderly population has been increasing globally, CVD may become a more important public health problem in the future. This report examines the prevalence of cardiovascular risk factors in the elderly in Ankara, Turkey. This was a cross-sectional survey and included a total of 2720 individuals living in the Ankara district. Trained research staff administered a standard questionnaire in the participants’ homes and worksites. The questionnaire collected information on clinical and demographic characteristics and a self-reported medical history, including past history of hypertension, diabetes, hyperlipidemia, coronary artery disease, coronary artery by-pass graft operation, and cerebrovascular accident. The mean age of the study participants was 69.5 ± 7.2 years. The study identified 1298 women (78.1%) and 753 men (71.2%) with hypertension, and the overall prevalence of hypertension was 75.4%. A total of 739 (27.2%) people had diabetes mellitus, and, of these people, 603 (81.6%) were hypertensive. A total of 1361 people had hyperlipidemia, and 1103 of these patients were also hypertensive. The overall prevalence of obesity was 27.2%. A total of 553 (20.3%) people were smokers. Our findings indicate that cardiovascular risk factors are very common in the elderly. To maximize risk reduction, physicians must take aggressive measures to decrease cardiovascular risk factors.

Oncologists’ perspectives on medical marijuana for the elderly.

2019 ◽  
Vol 37 (31_suppl) ◽  
pp. 78-78
Author(s):  
Desiree Rachel Azizoddin ◽  
Andrea Catherine Enzinger ◽  
Alexi A. Wright ◽  
Miryam Yusufov ◽  
Fangxin Hong ◽  
...  
Keyword(s):  
Older Adults ◽  
Cancer Patients ◽  
Medical Marijuana ◽  
The Elderly ◽  
Cross Sectional Survey ◽  
Chi Square ◽  
Cross Sectional ◽  
Elderly Cancer Patients ◽  
Treatment Side Effects ◽  
Nationally Representative

78 Background: Cancer patients are increasingly using medical marijuana (MM) to manage symptoms and treatment side effects. Although cancer disproportionately affects the elderly, little is known about oncologists’ attitudes toward MM in this population. We surveyed US oncologists’ beliefs about the benefits of MM for older adults, and examined their associations with oncologists’ perceptions of MM efficacy and safety. Methods: 232 out of 400 randomly selected U.S. oncologists (63% response rate) completed a cross-sectional survey about their beliefs and recommendations regarding MM for cancer patients. Using Chi-square tests, we examined associations between oncologists’ demographics, their perceptions of geriatric MM use, as well as beliefs about comparative effectiveness of MM for cancer related symptoms, and comparative risks of MM to prescription opioids. Results: Among 232 oncologists included in this cohort, 109 (47.0%) reported that MM had at least some benefit for elderly cancer patients, 66 (28.4%) responded it was rarely or never beneficial, and 57 (24.6%) reported not knowing. There were no significant associations between oncologists’ beliefs about MM’s benefit for older adults and their sociodemographic characteristics. Those who believed MM was beneficial for the elderly were significantly more likely to report that MM was at least as effective as standard treatments for the following indications: coping (58.3% vs. 26.6%), appetite (83.3% vs 58.5%), depression (46.3% vs 25.0%), and nausea (66.7% vs 33.9%), respectively ( p < 0.001). In contrast, oncologists’ beliefs about MM for the elderly were not significantly associated with perceptions of the comparative risks of MM ( p > 0.05). Conclusions: In this nationally-representative sample of US oncologists, about half thought MM was beneficial for older adults with cancer. Oncologists’ support of MM for older adults was associated with perceptions of MM’s efficacy but was not associated with perceptions of MM’s risks. More research is needed regarding the safety and efficacy of MM to guide oncologists’ recommendations about its use in older adults.

Public knowledge about dementia in South Korea: a community-based cross-sectional survey

2014 ◽  
Vol 27 (3) ◽  
pp. 463-469 ◽  
Author(s):  
Hyun-Ju Seo ◽  
Dong Young Lee ◽  
Mi Ra Sung
Keyword(s):  
South Korea ◽  
Quantitative Methods ◽  
The Elderly ◽  
Population Based ◽  
Cross Sectional Study ◽  
Public Knowledge ◽  
Cross Sectional Survey ◽  
Community Based ◽  
Cross Sectional ◽  
General Populations

ABSTRACTBackground:The highest increase in the prevalence of dementia in the elderly population is expected in South Korea than in any other country in the world. However, there is no assessment of the community-based general populations’ understanding of dementia in South Korea, in spite of the increasing burden of dementia. Thus, this study assessed the public knowledge about dementia.Methods:This is a population-based, cross-sectional study of 2,189 participants, aged 10 years or older, and living in Seoul, South Korea. A 12-item questionnaire with true/false responses was used to assess the knowledge about dementia from June to November 2011. The data obtained were analyzed using quantitative methods.Results:The mean score for the knowledge about dementia was 9.0 ± 2.1 points out of 12 points. More than half of the respondents (52.7%) reported that dementia is not treatable, and one-third of the participants did not know that Alzheimer's disease is the most common cause of dementia. The level of dementia knowledge was negatively associated with increasing age, and positively associated with higher education level.Conclusions:Our results suggest that although laypersons had a fair knowledge about dementia, further educational programs and campaigns are needed to improve knowledge about dementia, more focusing on elderly adults as the target audience and emphasizing the causes and treatments of dementia as educational contents.

Factors Associated with Suboptimal Analgesic use in Community-Dwelling Elderly

1996 ◽  
Vol 30 (7-8) ◽  
pp. 739-744 ◽  
Author(s):  
Joseph T Hanlon ◽  
Gerda G Fillenbaum ◽  
Stephanie A Studenski ◽  
Thandi Ziqubu-Page ◽  
William E Wall
Keyword(s):  
Functional Status ◽  
White Women ◽  
The Elderly ◽  
Epidemiologic Studies ◽  
Community Dwelling ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Financial Status ◽  
Factors Associated ◽  
Analgesic Use

OBJECTIVE: To examine patterns and factors associated with overall and suboptimal analgesic use among community-dwelling elderly. DESIGN: Cross-sectional survey. SETTING: Five-county urban and rural region in Piedmont, NC. PARTICIPANTS: A stratified random sample from the Duke Established Populations for Epidemiologic Studies of the Elderly of 3973 participants aged 65 years or older. MAIN OUTCOME MEASURES: Use of any analgesic medication, suboptimal analgesic use (taking 2 or more analgesics from the same class, using 3 or more analgesics concurrently, or use of an analgesic that has a major interaction with another drug). RESULTS: Analgesics were used by 60.4% of the participants. Use was more likely for those who had physical functional impairment, a history of cardiovascular disease, one or more health visits in the previous year, or were female. Use was less likely for older participants and for African-Americans with adequate financial status. Suboptimal use occurred for 9.2% of analgesic users. Therapeutic duplication was more likely in those who were depressed, needed help with basic activities of daily living, or used alcohol, and was less likely in those with adequate financial status. Multiple analgesic use was more likely in those who were depressed, had impaired physical functional status, had one or more health visits in the previous year, were African-American (of either sex), or were white women. Only two persons had a potential major analgesic-drug interaction. CONCLUSIONS: Suboptimal analgesic use is common in community-dwelling elderly, and its risk is consistently increased in those who are depressed or have impaired functional status.

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