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Inappropriate Prescribing Risks for Older Adults

Core Concepts
Prescribing quality for older adults is similar between physicians and nurse practitioners.
The study published in Annals of Internal Medicine highlights the risks of inappropriate prescribing for older adults. Key points include: Inappropriate prescribing rates are similar between physicians and nurse practitioners. Older adults are vulnerable to adverse drug events due to comorbidities and physiological changes. The focus should be on individual clinician prescribing performance rather than prescriptive authority. Women are more susceptible to drug-related harm, with higher rates of inappropriate prescribing. The Beers Criteria is used to define prescriptive quality for older adults. Antidepressants, muscle relaxants, and hypnotics are among the most frequently inappropriately prescribed medications. Clinicians should use criteria like STOPP/START and the DRUGS framework to guide decision-making. Prescribers should avoid prescribing cascades to prevent adverse events. The study was funded by grants from Robert Wood Johnson Foundation and National Science Foundation.
Roughly 2% of prescriptions to older patients appear to be inappropriate. Adjusted rates were 1.66 per 100 prescriptions for NPs vs 1.68 per 100 prescriptions for physicians. Ten medications accounted for 99.5% of the potentially inappropriate medications prescribed.
"Older adults often have more than one chronic condition and are prescribed multiple medications to manage these conditions, putting them at risk for adverse events." - Dr. Paula Rochon

Key Insights Distilled From

by Brittany Var... at 11-01-2023
Older Adults at Risk From Inappropriate Prescribing

Deeper Inquiries

How can healthcare systems ensure appropriate prescribing practices for older adults?

Healthcare systems can ensure appropriate prescribing practices for older adults by implementing strategies such as regular medication reviews, utilizing tools like the Beers Criteria and STOPP/START Criteria to guide prescribing decisions, promoting interprofessional collaboration between healthcare providers, and educating both prescribers and patients about the risks associated with inappropriate prescribing. Additionally, systems can encourage open communication between patients and providers regarding medication goals and potential side effects, as well as monitoring for medication-related adverse events to prevent harm to older adults.

What are the implications of higher rates of inappropriate prescribing for women?

Higher rates of inappropriate prescribing for women can have significant implications, as women are physiologically more susceptible to drug-related harm. This can lead to an increased risk of adverse drug events, medication interactions, and potential harm to older women. Additionally, inappropriate prescribing can exacerbate existing health conditions, increase the likelihood of hospitalizations, and contribute to a decline in overall health outcomes for women. Addressing these higher rates of inappropriate prescribing for women is crucial to improving the quality of care and safety for this vulnerable population.

How can the use of criteria like STOPP/START and the DRUGS framework improve patient outcomes?

The use of criteria like STOPP/START and the DRUGS framework can significantly improve patient outcomes by providing prescribers with evidence-based guidelines for appropriate medication management in older adults. These criteria help identify potentially inappropriate medications, reduce the risk of adverse drug events, minimize medication-related harm, and optimize medication regimens based on individual patient needs. By following these frameworks, healthcare providers can enhance medication safety, improve treatment efficacy, reduce polypharmacy, and ultimately enhance the overall quality of care for older adults.