Interventions that can reduce inappropriate prescribing in the elderly: A systematic review

Kaur, S., Mitchell, G., Vitetta, L. and Roberts, M.S. (2009) Interventions that can reduce inappropriate prescribing in the elderly: A systematic review. Drugs & Ageing, 26 12: 1013-1028. doi:10.2165/11318890-000000000-00000

Author Kaur, S.
Mitchell, G.
Vitetta, L.
Roberts, M.S.
Title Interventions that can reduce inappropriate prescribing in the elderly: A systematic review
Formatted title
Interventions that can reduce inappropriate prescribing in the elderly: A systematic review
Journal name Drugs & Ageing   Check publisher's open access policy
ISSN 1170-229X
Publication date 2009
Sub-type Critical review of research, literature review, critical commentary
DOI 10.2165/11318890-000000000-00000
Volume 26
Issue 12
Start page 1013
End page 1028
Total pages 16
Editor Roger Olney
Place of publication New Zealand
Publisher Adis International
Collection year 2010
Language eng
Subject C1
920205 Health Education and Promotion
111702 Aged Health Care
Formatted abstract
Inappropriate prescribing of medicines may lead to a significant risk of an adverse drug-related event. In particular, prescribing may be regarded as inappropriate when alternative therapy that is either more effective or associated with a lower risk exists to treat the same condition. This review aims to identify interventions and strategies that can significantly reduce inappropriate prescribing in the elderly. The review is based on a search of electronic databases using synonyms of keywords such as ‘elderly’, ‘interventions’, ‘optimized prescribing’ and ‘inappropriate prescribing’ to identify reported interventions intended to improve inappropriate prescribing in the elderly. A total of 711 articles published in English were retrieved and considered. Of these, 24 original studies, involving 56 to 124 802 participants, met the inclusion criteria and were included in the systematic review. In 16 studies, the statistical power used to assess the impact of the intervention was >90% at a significance level of α = 0.05.

Various interventions were included in this study, such as educational interventions, medication reviews, geriatricians' services, multidisciplinary teams, computerized support systems, regulatory policies and multi-faceted approaches. Because of variability in assessment methodologies, mixed responses were found for education interventions aimed at improving inappropriate prescribing. For example, some studies did not assess what data were required to define whether a given level of intervention would be adequate, and others did not consider how many participants would be needed to demonstrate that a significant difference existed.

Each of the three computerized support system interventions reported produced a significant enhancement in both prescribing and dispensing practices. Pharmacist interventions in community and hospital settings were evaluated in seven studies. However, variable criteria were used, with two studies using the Medication Appropriateness Index, another two studies using self-designed criteria for inappropriate prescribing, and the remaining three studies using Beers' criteria. A difficulty in assessing studies involving nursing home residents is that both consultant pharmacists and onsite pharmacist services may be involved, and, in one of the studies, only the role of the consultant pharmacist was considered. One of the most effective interventions appeared to be multidisciplinary case conferences involving a geriatrician, which resulted in a number of examples of reduced inappropriate prescribing in both community and hospital settings. As the effect of regulatory policies as an intervention is dependent on the target population involved, the effectiveness of this type of intervention was variable.

Different strategies may be useful in reducing inappropriate prescribing in the elderly. It is not clear whether combined strategies undertaken simultaneously have a synergistic effect.
Keyword Prescribing
Alternative Therapy
Q-Index Code C1
Q-Index Status Confirmed Code

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: 2010 Higher Education Research Data Collection
School of Medicine Publications
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 98 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 119 times in Scopus Article | Citations
Google Scholar Search Google Scholar
Created: Sun, 10 Jan 2010, 00:07:17 EST