INAPPROPRIATE MEDICATION USE IN COMMUNITY-RESIDING OLDER PERSONS

Background: Elderly patients taking inappropriate drugs are at increas ed risk for adverse outcomes. We investigated the prevalence of inappr opriate drug use and its predisposing factors in community-residing ol der persons. Methods: We conducted in-home interviews with 414 subject s aged 75 years and older living in the community of Santa Monica, Cal if. Inappropriate medication use was evaluated using explicit criteria developed through a modified Delphi consensus process. These criteria identified drugs that should generally be avoided in elderly communit y-residing subjects regardless of dosage, duration of therapy, or clin ical circumstances. Results: Based on these conservative criteria, 14. 0% of the subjects were using at least one inappropriate drug. The mos t common examples were long-acting benzodiazepines, persantine, amitri ptyline, and chlorpropamide. Subjects using three or more prescription drugs, compared with one or two, were more likely to be taking an ina ppropriate medication (odds ratio, 3.9; 95% confidence interval, 1.9 t o 7.9). Furthermore, subjects with depressive symptoms had a higher ri sk of receiving inappropriate medications than nondepressive subjects (odds ratio, 2.2; 95% confidence interval, 1.1 to 4.1). Conclusions: I nappropriate drug use is a common problem in community-residing older persons. The risk of inappropriate drug use is increased in patients t aking multiple medications and in patients with depressive symptoms.