Year in Review: Medication Mishaps in the Elderly

doi:10.1016/j.amjopharm.2011.01.003

Am J Geriatr Pharmacother. Author manuscript; available in PMC 2012 September 25.

Published in final edited form as:

Am J Geriatr Pharmacother. 2011 February; 9(1): 1–10.

doi: 10.1016/j.amjopharm.2011.01.003

PMCID: PMC3457784

NIHMSID: NIHMS383803

Year in Review: Medication Mishaps in the Elderly

Emily P. Peron, PharmD,¹ Zachary A. Marcum, PharmD,¹ Richard Boyce, PhD,² Joseph T. Hanlon, PharmD, MS,^1,^2,^3,⁴ and Steven M. Handler, MD, PhD^1,^2,³

¹Division of Geriatric Medicine, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA

²Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, Pittsburgh, PA

³Geriatric Research Education and Clinical Center and Center for Health Equity Research and Promotion and, VA Pittsburgh Health System Pittsburgh, PA

⁴Department of Pharmacy and Therapeutics, School of Pharmacy and Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA

Send correspondence to Dr. Hanlon at the Department of Medicine (Geriatrics), University of Pittsburgh, Kaufman Medical Building-Suite 514, 3471 5^th Ave, Pittsburgh, PA 15213; Tel#: 412-692-2361; Fax#: 412-692-2370; Email: jth14/at/pitt.edu

The publisher's final edited version of this article is available at Am J Geriatr Pharmacother

See other articles in PMC that cite the published article.

Abstract

Objective

This paper reviews articles from the past year that examined medication mishaps (i.e., medication errors and adverse drug events [ADEs]) in the elderly.

Methods

The MEDLINE and EMBASE databases were searched for English-language articles published in 2010 using a combination of search terms including: medication errors, medication adherence, medication compliance, suboptimal prescribing, monitoring, adverse drug events, adverse drug withdrawal events, therapeutic failures, and aged. A manual search of the reference lists of the identified articles and the authors’ article files, book chapters and recent reviews was conducted to identify additional publications. Five studies of note were selected for annotation and critique. From this literature search, this paper also provides a selected bibliography of manuscripts published in 2010 (excluding those previously published in the American Journal of Geriatric Pharmacotherapy or by one of the authors) that address various types of medication errors and ADEs in the elderly.

RESULTS

Three studies addressed types of medication errors. One study examined underuse (due to prescribing) as a type of medication error. This was a before-and-after study from the Netherlands reported that those who received comprehensive geriatric assessments had a reduction in the rate of under-treatment of chronic conditions over a third (from 32.9% to 22.3%, p < 0.05). A second study focused on reducing medication errors due to the prescribing of potentially inappropriate medications. This quasi-experimental study found that a computerized provider order entry clinical decision support system decreased the number of potentially inappropriate medications ordered for patient’s ≥ 65 years of age who were hospitalized (11.56 before to 9.94 orders per day after, p < 0.001). The third medication error study was a cross-sectional phone survey of managed-care elders. This study found that more blacks than whites had low antihypertensive medication adherence as per a self-reported measure (18.4% vs. 12.3% respectively; p < 0.001). Moreover, blacks compared to whites used more complementary and alternative medicine (CAM) for the treatment of hypertension (30.5% vs. 24.7%, respectively; p = 0.005). In multivariable analyses stratified by race, among blacks, those that used CAM were more likely than those that did not to have low antihypertensive medication adherence (prevalence rate ratio 1.56, 95% confidence interval 1.14–2.15, p= 0.006).

The remaining two articles each addressed some form of medication adverse events. A case-control study of Medicare Advantage patients revealed for the first time that skeletal muscle relaxant use was significantly associated with an increased fracture risk (adjusted odds ratio 1.40, 95% confidence interval 1.15–1.72; p < 0.001). This increased risk was even more pronounced with the concomitant use of benzodiazepines. Finally, a randomized controlled trial across 16 centers in France used a one-week educational intervention about high-risk medications and ADEs directed at rehabilitation health care teams. They found that the rate of ADEs in the intervention group was lower than that in the usual care group (22% vs. 36%, respectively, p = 0.004).

CONCLUSION

Information from these studies may be used to advance health professionals’ understanding of medication errors and ADEs and may help guide research and clinical practices in years to come.

Keywords: medication errors, suboptimal prescribing, medication adherence, drug monitoring, adverse drug events, aged

INTRODUCTION

Medication mishaps in the elderly range from medication errors to medication-related adverse patient events (MRAPEs).¹ Older adults are at an increased risk of experiencing medication mishaps because of their frequent use of multiple medications (i.e., polypharmacy) and the pharmacokinetic and pharmacodynamic changes that occur with aging.² In fact, it is estimated that elderly people have four times greater odds of being hospitalized for a medication mishap than those <65 years of age (16.6% vs. 4.1%).³ As the geriatric population continues to grow, critical evaluation of the literature may help to identify current problems and develop solutions for the future. Therefore, an updated review of medication mishaps among older adults remains timely and practical.

METHODS

MEDLINE and EMBASE databases ere searched for articles from published in 2010 in English involved humans, and contains one or more of the fallowing terms: medication errors, medication adherence, medication compliance, suboptimal prescribing, monitoring, adverse drug events, adverse drug withdrawal events, therapeutic failures, and aged. A manual search of the reference lists of the identified articles and the authors’ article files, book chapters, and recent reviews was conducted to identify additional publications. Those studies that, in the authors’ opinions, addressed key medication-related issues facing older people were included in the review. Articles were categorized according to a previously described classification system for medication errors and MRAPEs.¹ Selected additional articles of interest from 2010 have been categorized and are listed in a bibliography (Appendix 1).

RESULTS

Potential Under-Prescribing

Tulner et al. published the results of an observational study assessing the impact of comprehensive geriatric assessment (CGA) on the prevalence of under-treatment in the elderly.⁴ Under-treatment can be defined as the omission of indicated drug therapies for the treatment or prevention of a disease, and it has been associated with increased morbidity and mortality as well as decreased quality of life.²

In 2004, 807 geriatric outpatients were recruited for a prospective descriptive study of CGA from the Geriatric Day Clinic of an Amsterdam, Netherlands hospital.⁴ From this initial group, 516 were identified as having at least one of 10 commonly under-treated disease (i.e., hypertension, angina pectoris, cerebrovascular accident [CVA], transient ischemic attack, peripheral arterial disease, myocardial infarction [MI], heart failure, atrial fibrillation, diabetes mellitus, osteoporosis) or requiring preventive therapy for a potential adverse drug event (ADE) (i.e. bisphosphonates for long-term corticosteroid use, proton pump inhibitors [PPIs] for long-term non-steroidal anti-inflammatory [NSAID] use, laxatives for long-term morphine use). Patients were considered under-treated if lacking any drugs indicated for the above conditions in accordance with 2004 guidelines from the Dutch College of General Practitioners (Dutch GPs). Other national and international interdisciplinary guidelines were used when Dutch GP guidelines were unavailable for specific disease states (e.g., CVA, MI). Treatment drugs of interest were antihypertensives, antithrombotics, oral anticoagulants (OACs), ACE inhibitors, beta blockers, anti hyperglycemics, and bisphosphonates. As a secondary objective, the prevalence of contraindications for OACs, other antithrombotics, and beta blockers was investigated; no other reasons were considered adequate for justifying under-treatment.

In the Geriatric Day Clinic, geriatricians and geriatric residents conducted CGAs, which consisted of a complete medical and medication history, assessment using the Medication Appropriateness Index, and an evaluation of current complaints and functional limitations. Potential problems with under-prescribing were discussed by both the study physician and pharmacist, and decisions were made about the changing or prescribing of medications.

Just over half (53%) of the patients were female and the average age was 81.5 years. Prior to CGA, 32.9% (n=170) of patients were identified as being under-treated. Following CGA, under-treatment was significantly reduced (22.3%, p<0.01). Examples of conditions whose under-treatment was resolved with CGA included prescribing of bisphosphonates in those taking chronic oral steroids and giving PPIs to those receiving chronic NSAIDs. One factor associated with under-treatment at follow-up was polypharmacy (≥5 medications) (76.5% vs. 68.8% in those without polypharmacy; p = 0.068). Similarly, patients with contraindications to medications (e.g., antithrombotics, beta blockers) were more likely to be under-treated than not (49.6% vs. 11.2%; p < 0.01).

This study illustrates that nearly one-third of elderly outpatients from Europe before CGA had evidence of under-treatment. This rate is considerably less than the 50–66% rate of under-treatment reported for elderly outpatients in the United States.⁵ This research also supports previous findings from a randomized controlled trial that CGA reduces suboptimal prescribing, including under-treatment, in the aged.⁶

This study is limited by its lack of a control group, unblinded evaluation of under-treatment, and lack of control for historical or confounding factors that might have influenced the study findings. Additionally, this study is based on data collected in one hospital in the Netherlands in 2004 and guidelines from that year; as such, differences in other populations, prescriber practices, and treatment and prevention guidelines may limit the study’s generalizability.

Potential Inappropriate Prescribing

Mattison et al. conducted a quasi-experimental study (before-and-after without a control group) to determine whether a computerized provider order entry (CPOE) with clinical decision support (CDS) system could decrease orders for potentially inappropriate medications (PIMs), as defined by a subset of Beers list medications in hospitalized older patients.^7,8 The study involved inpatients ≥ 65 years who were admitted to a large urban academic medical center in Boston, Massachusetts. The “before” period was between June 1, 2004 to November 29, 2004, and the “after” period was from March 17, 2005 to August 30, 2008. The main outcome measure was the rate of orders for PIMs before and after the CPOE with CDS system was deployed. Prescribers received alerts requiring responses before confirming their orders. Each alert contained an explanation for the warning, a list of conditions that could place a patient at increased risk, and, where appropriate, advised an alternative medication or dose reduction. During the course of the study, the mean rate of ordering PIMs decreased from 11.56 before to 9.94 orders per day after the implementation of a CPOE with CDS system (difference, 1.62; p < 0.001). There was no evidence that the effect waned over time. There were also no appreciable changes in the rate of medication orders that were not targeted after CPOE with CDS implementation or for which only dose reduction was recommended. These effects persisted when analyzed with autoregressive models that accounted for secular trends and season (p < 0.001). The authors concluded that specific alerts embedded into a CPOE system, used in patients ≥ 65 years, can decrease the number of orders of PIMs quickly and specifically.

While this study adds to previous knowledge that information technology interventions may improve the quality of prescribing for older adults, it also has some potential limitations worth noting.⁹ First, the lack of random assignment and a control group reduces the ability to establish causality. Although study analyses factored in the time period to address historical factors that could account for the findings, it did not control for other potential patient, prescriber, or health system factors that could result in confounding the relationship between the intervention and outcome measure. Second, no information was provided about the impact of the intervention on patient outcomes. This is important given the questionable relationship between PIM and ADEs.¹⁰ Third, the CPOE with CDS system used a non-scientific method for alert development and was unable to distinguish between orders for new vs. chronic PIMs, and lacked linkage with an electronic medication administration system to determine if medication had actually been administered. Finally, the generalizability of the study is limited as the investigators developed their own software programs to conduct the intervention that are not available to the public.

Medication adherence

Krousel-Wood et al. reported on the association between complementary and alternative medicine (CAM) use and antihypertensive medication adherence in older black and white adults in a sample of patients enrolled in a large managed care organization.¹¹ The authors included 2,180 participants (black, n=670; white, n=1,510) with hypertension who completed the baseline interview of the Cohort Study of Medication Adherence among Older Adults (CoSMO). Participants were telephoned to complete the baseline survey, consisting of an assessment of sociodemographic factors, clinical factors, healthcare system factors, antihypertensive medication treatment-related variables, CAM use for blood pressure management, and adherence to antihypertensive medication. CAM use was assessed with items from a previously validated survey and included three domains: (1) health food (e.g., fish oil, fiber, L-arginine, co-enzyme Q10), (2) herbal supplements (e.g., garlic, snakeroot, yarrow, Chinese herbs), and (3) relaxation techniques (e.g., yoga, meditation, other relaxation techniques). ¹² A CAM use variable was created for those who reported use from any of these domains at least several times or on a regular basis in the year prior. Self-reported antihypertensive adherence was evaluated with the 8-item Morisky Medication Adherence Scale (MMAS-8), which has previously been shown to be reliable and valid.^13,14 A dichotomous antihypertensive adherence variable was created using the MMAS-8 score to identify subjects with low medication adherence (low adherence < 6 vs. not low ≥ 6). Finally, the following question was asked to assess potential cost-related nonadherence: “In the last year, have you ended up taking less high blood pressure medication than was prescribed because of the cost?” All analyses were stratified by race to assess for any racial differences in the effect of CAM use on medication adherence.

Overall, the sample had relatively low self-reported nonadherence, with 14.1% of participants having an MMAS-8 score < 6. About a quarter of the sample (26.5%) used CAM in managing their blood pressure. Bivariate analysis revealed that significantly more blacks than whites were CAM users (30.5% vs. 24.7%; P = 0.005) and that more blacks had low antihypertensive medication adherence (18.4% vs. 12.3%; P < 0.001). After adjusting for sociodemographic characterics, depression, and cost-related nonadherence, the risk of low antihypertensive medication adherence associated with CAM use was increased in blacks (prevalence ratio 1.56; 95% confidence interval 1.14–2.15) but not in whites (prevalence ratio 0.95; 95% confidence interval 0.70–1.29).

The study findings are important because they clearly showed that CAM use was more common in older blacks and may have a negative effect on antihypertensive medication adherence. The greater use of CAM in black subjects is in consistent with some studies but not with others where blacks used less CAM than whites. ¹⁵. However, since older adults often do not report CAM use to their primary care physicians, the study’s results reinforce the recommendation to question about the use of non-prescription medications when taking a medication history. Another key finding from this study is the importance of assessing cost-related nonadherence when evaluating medication adherence in older adults, as this factor was shown to be significantly associated with low adherence in both blacks and whites.

Some potential limitations of this study include the cross-sectional design and self-reported nature of the data, both of which can lead to potential bias. Moreover, outcomes such as blood pressure control that could be influenced by medication adherence were not assessed in this study. Finally, the study was focused on one disease and included older adults with from only one region of the United States. Thus, further research is needed with other co-morbid conditions and other populations to improve the generalizability of the results.

Medication Related Adverse Patient Events

Golden et al. conducted a case-control study of a nationwide Medicare Advantage (MA) population to identify the risk of fracture injuries for patients prescribed skeletal muscle relaxants (i.e., carisoprodol, chlorzoxazone, cyclobenzaprine, metaxalone, methocarbamol).¹⁶ Cases and controls were identified from the population of persons ≥ 65 years who were enrolled for at least 90 days in a MA plan between June 2004 and May 2007. Cases were defined as having at least one ICD-9-CM (International Classification of Diseases, 9th Revision, Clinical Modification) code for fracture in their medical record and at least one prescription within the three months prior to the date of the fracture event. Controls were persons who had been prescribed at least one drug within the three months prior to the matched case’s fracture event, but who did not have an ICD-9-CM code for fracture in their medical record during the study period. Controls were matched 1:1 with cases on age, sex, state of residence, specific MA plan, coverage period, and Charlson co-morbidity index. After adjusting for other potential covariates, (i.e., age, fibromyalgia, urinary incontinence, unspecified disorders of the back, diagnoses associated with the use of skeletal muscle relaxants, and the use of antidepressants or atypical antipsychotics), those exposed to skeletal muscle relaxants had an increased risk of a fracture (odds ratio = 1.40; 95% CI 1.15–1.72). However, there was no significant increase in risk for persons exposed to combinations of ≥ 2 skeletal muscle relaxants over that found for the use of a single skeletal muscle relaxant. An increased risk was also seen for both long-acting benzodiazepines (OR = 1.90; 95% CI 1.49–2.43) and short-acting benzodiazepines (OR = 1.33; 95% CI 1.15–1.55). The combination of a potentially inappropriate skeletal muscle relaxant with either a long- or short-acting benzodiazepine was associated with an even greater risk, with ORs of 2.66 (95% CI 1.94–3.65) and 1.86 (95% CI 1.45–2.40), respectively.

This study is important since falls and fall-related injury remain a very important public health problem for adults ≥ 65 years with 28–35% of community-dwelling persons from this age group falling at least once per year and 5% of falls resulting in fractures.¹⁷ Moreover, it provides further justification for the inclusion of skeletal muscle relaxants on the Beers list as PIMs.⁸ Prior to this study, there have only been two studies showing a link between anticholinergic drug use and falls in the elderly.^18,19 This study also indicates that the use of central nervous system medications from two drug classes appears to significantly increases the risk of fracture. This is consistent with recent work showing that CNS polypharmacy increases the risk of recurrent falls in community-dwelling elders.²⁰

This study has some limitations worth noting. There is a high probability that there was bias in the measurement of the outcome. No attempt was made to confirm by medical record review that a fracture actually occurred and was not due to other causes such as a motor vehicle accident or cancer. Moreover, not all fractures come to the hospital for treatment. For example, in older adults, skeletal compression fractures can be a common manifestation of osteoporosis sometimes found inadvertently through x-ray tests. In addition, ICD-9 codes for fractures other than the patella or hip have positive predictive values less than 93%.^21,22 The authors note that data which would enable these factors to be included in the analysis were not generally present in the investigators’ MA claims database. There is also potential misclassification of exposure. Cases and controls qualified as being exposed to a muscle relaxant or benzodiazepine if pharmacy records showed at least one prescription within the three months prior to the date of a case fracture diagnosis. However, since skeletal muscle relaxants are usually indicated for short-term use this might have led to the inclusion of persons who were no longer taking the medication. In addition, dispensing of medications may not represent the medication being administered or taken. One also cannot rule out the presence of confounding due to other known risk factors for falls and fractures such as gait, depression, cognitive impairment, mobility limitations, impaired activities of daily living, and history of falls.¹⁷

Trivalle et al. published the results of a randomized controlled study designed to reduce the rate of ADEs in 576 older hospitalized patients from 16 centers in France.²³ After a two-week lead-in period, these 16 units were randomized to control (usual care) or educational intervention. The one-week educational intervention consisted of the education of rehabilitation health-care teams about important geriatric pharmacotherapy topics (i.e., risk of NSAIDs, benzodiazepines and anticholinergics, appropriate use of opioids including the need for slow titration and regular laxative regimens, and the need to calculate estimated creatinine clearance for renally cleared drugs and adjust dose accordingly). The follow-up period consisted of two weeks. The main outcome was probable ADEs (i.e., drug came before event, known effect, improvement with medication stoppage, and not due to patient’s clinical condition). These potential ADEs were detected by an investigator who reviewed the medical record and talked with nurses and physicians taking care of patients. The preventability of probable ADEs was evaluated by a multidisciplinary team of physicians and pharmacists. Overall, there were 122/475 (25.7%) ADEs in the intervention and control wards before randomization and this was reduced to 38/196 (19.4%) in those wards randomized to the intervention group by the end of the study. In contrast, there were 63/241 (26.1%) ADEs in the control group after the intervention. Overall, 28% of ADEs were deemed preventable.

The importance of this study is that it is only the fifth randomized controlled study to examine ADEs/adverse drug reactions (ADRs) as the main outcome.^24–27 Moreover, it appears to be the first randomized controlled trial of an intervention to reduce ADEs in the hospital setting restricted to the elderly. However, there are some potential issues with this study. First, the statistical analysis did not take into account clustering since the unit of randomization was hospital units as opposed to patients. There is also potential misclassification because a formal validated ADR causality algorithm (e.g., Naranjo) was not utilized.²⁸ No information was noted about whether the ADE evaluators were blinded to group assignment. Finally, the generalizability to hospitals from other countries is unknown.

CONCLUSIONS

Information from these studies may be used to advance health professionals’ understanding of medication errors and ADEs and may help guide research and clinical practices in years to come.

Acknowledgments

This study was primarily supported by National Institute on Aging grants and contracts (R01AG027017, P30AG024827, T32 AG021885, K07AG033174, R56AG027017, R01AG034056), a National Institute of Mental Health grant (R34 MH082682), a National Institute of Nursing Research grant (R01 NR010135), an Agency for Healthcare Research and Quality grants (R01 HS017695, R01 HS018721, K12 HS019461), and a VA Health Services Research grant (IIR-06-062).

Appendix 1. Selected Bibliography of Manuscripts Published in 2010 on Medication Mishaps in the Elderly*

MEDICATION ERRORS

Suboptimal prescribing

Cahir C, Fahey T, Teeling M, Teljeur C, Feely J, Bennett K. Potentially inappropriate prescribing and cost outcomes for older people: a national population study. Br J Clin Pharmacol. 2010;69:543–52. [PubMed]
Castelino RL, Bajorek BV, Chen TF. Retrospective evaluation of home medicines review by pharmacists in older Australian patients using the medication appropriateness index. Ann Pharmacother. 2010;44:1922–9. [PubMed]
Castelino RL, Hilmer SN, Bajorek BV, Nishtala P, Chen TF. Drug Burden Index and potentially inappropriate medications in community-dwelling older people: the impact of Home Medicines Review. Drugs Aging. 2010;27:135–48. [PubMed]
Caughey GE, Roughead EE, Shakib S, McDermott RA, Vitry AI, Gilbert AL. Comorbidity of chronic disease and potential treatment conflicts in older people dispensed antidepressants. Age Ageing. 2010;39:488–94. [PubMed]
Caughey GE, Roughead EE, Vitry AI, McDermott RA, Shakib S, Gilbert AL. Comorbidity in the elderly with diabetes: Identification of areas of potential treatment conflicts. Diabetes Res Clin Pract. 2010;87:385–93. [PubMed]
Chang C-B, Chan D-C. Comparison of published explicit criteria for potentially inappropriate medications in older adults. Drugs Aging. 2010;27:947–57. [PubMed]
Climente-Martí M, García-Mañón ER, Artero-Mora A, Jiménez-Torres NV. Potential risk of medication discrepancies and reconciliation errors at admission and discharge from an inpatient medical service. Ann Pharmacother. 2010;44:1747–54. [PubMed]
Cooper C, Blanchard M, Selwood A, Livingston G. Antidementia drugs: prescription by level of cognitive impairment or by socio-economic group? Aging Ment Health. 2010;14:85–9. [PubMed]
Donovan JL, Kanaan AO, Thomson MS, et al. Effect of clinical decision support on psychotropic medication prescribing in the long-term care setting. J Am Geriatr Soc. 2010;58:1005–7. [PubMed]
Fitzgerald SP, Bean NG. An analysis of the interactions between individual comorbidities and their treatments--implications for guidelines and polypharmacy. J Am Med Dir Assoc. 2010;11:475–84. [PubMed]
Fu AZ, Tang AS, Wang N, Du DT, Jiang JZ. Effect of Medicare Part D on potentially inappropriate medication use by older adults. J Am Geriatr Soc. 2010;58:944–9. [PubMed]
Garfinkel D, Mangin D. Feasibility study of a systematic approach for discontinuation of multiple medications in older adults: addressing polypharmacy. Arch Intern Med. 2010;170:1648–54. [PubMed]
Golden AG, Fass J, Tewary S, Stefanacci RG, Roos BA. Cost consideration by Medicare Part D plans may promote the use of potentially inappropriate medications. J Am Geriatr Soc. 2010;58:979–81. [PubMed]
Guirguis K. The use of nonprescription medicines among elderly patients with chronic illness and their need for pharmacist interventions. Consult Pharm. 2010;25:433–9. [PubMed]
Hwang U, Richardson LD, Harris B, Morrison RS. The quality of emergency department pain care for older adult patients. J Am Geriatr Soc. 2010;58:2122–8. [PMC free article] [PubMed]
Jennings S, Murphy N, McElwee D, Collins R, O’Neill D. Reluctance of older people to discontinue long-term benzodiazepines and related hypnotics. J Am Geriatr Soc. 2010;58:1205–6. [PubMed]
Kann IC, Biørn E, Lurås H. Competition in general practice: prescriptions to the elderly in a list patient system. J Health Econ. 2010;29:751–64. [PubMed]
Kinley J, Hockley J. A baseline review of medication provided to older people in nursing care homes in the last month of life. Int J Palliat Nurs. 2010;16:216–23. [PubMed]
Lam DP, Mak CF, Chan SM, Yao RW, Leung SS, You JH. Polypharmacy and inappropriate prescribing in elderly Hong Kong Chinese patients. J Am Geriatr Soc. 2010;58:203–5. [PubMed]
Lampela P, Hartikainen S, Lavikainen P, Sulkava R, Huupponen R. Effects of medication assessment as part of a comprehensive geriatric assessment on drug use over a 1-year period: a population-based intervention study. Drugs Aging. 2010;27:507–21. [PubMed]
Lang PO, Hasso Y, Dramé M, et al. Potentially inappropriate prescribing including under-use amongst older patients with cognitive or psychiatric co-morbidities. Age Ageing. 2010;39:373–81. [PubMed]
Lee CY, George J, Elliott RA, Stewart K. Prevalence of medication-related risk factors among retirement village residents: a cross-sectional survey. Age Ageing. 2010;39:581–7. [PubMed]
Levy HB, Marcus EL, Christen C. Beyond the beers criteria: a comparative overview of explicit criteria. Ann Pharmacother. 2010;44:1968–75. [PubMed]
Lund BC, Carnahan RM, Egge JA, Chrischilles EA, Kaboli PJ. Inappropriate prescribing predicts adverse drug events in older adults. Ann Pharmacother. 2010;44:957–63. [PubMed]
Maio V, Del Canale S, Abouzaid S. for the GAP Investigators. Using explicit criteria to evaluate the quality of prescribing in elderly Italian outpatients: a cohort study. J Clin Pharm Ther. 2010;35:219–29. [PubMed]
Meurer WJ, Potti TA, Kerber KA, et al. Potentially inappropriate medication utilization in the emergency department visits by older adults: analysis from a nationally representative sample. Acad Emerg Med. 2010;17:231–7. [PubMed]
Miquel MDC, Cuervo MS, Silveira ED, et al. Potentially inappropriate drug prescription in older subjects across health care settings. Eur Geriatr Med. 2010;1:9–14.
O’Mahony D, Gallagher P, Ryan C, et al. STOPP & START criteria: A new approach to detecting potentially inappropriate prescribing in old age. Eur Geriatr Med. 2010;1:45–51.
Padala KP, Padala PR, Potter JF. Statins: a case for drug withdrawal in patients with dementia. J Am Geriatr Soc. 2010;58:1214–6. [PubMed]
Page RL, 2nd, Linnebur SA, Bryant LL, Ruscin JM. Inappropriate prescribing in the hospitalized elderly patient: defining the problem, evaluation tools, and possible solutions. Clin Interv Aging. 2010;5:75–87. [PMC free article] [PubMed]
Parsons C, Hughes CM, Passmore AP, Lapane KL. Withholding, discontinuing and withdrawing medications in dementia patients at the end of life: a neglected problem in the disadvantaged dying? Drugs Aging. 2010;27:435–49. [PubMed]
Pozzi C, Lapi F, Mazzaglia G, et al. Is suboptimal prescribing a risk factor for poor health outcomes in community-dwelling elders? The ICARe Dicomano study. Pharmacoepidemiol Drug Saf. 2010;19:954. [PubMed]
Pyszka LL, Seys Ranola TM, Milhans SM. Identification of inappropriate prescribing in geriatrics at a Veterans Affairs hospital using STOPP/START screening tools. Consult Pharm. 2010;25:365–73. [PubMed]
Qato DM, Lindau ST, Conti RM, Schumm LP, Alexander GC. Racial and ethnic disparities in cardiovascular medication use among older adults in the United States. Pharmacoepidemiol Drug Saf. 2010;19:834. [PubMed]
RESPECT trial team. Effectiveness of shared pharmaceutical care for older patients: RESPECT trial findings. Br J Gen Pract. 2010;60:e10–9. e20–7. [PMC free article] [PubMed]
Roth MT, Esserman DA, Ivey JL, Weinberger M. Racial disparities in the quality of medication use in older adults: baseline findings from a longitudinal study. J Gen Intern Med. 2010;25:228–34. [PMC free article] [PubMed]
Ruggiero C, Dell’Aquila G, Gasperini B, et al. Potentially inappropriate drug prescriptions and risk of hospitalization among older, Italian nursing home residents: the ULISSE project. Drugs Aging. 2010;27:747–58. [PubMed]
Scott I, Jayathissa S. Quality of drug prescribing in older patients: is there a problem and can we improve it? Intern Med J. 2010;40:7–18. [PubMed]
Setoguchi S, Glynn RJ, Stedman M, Flavell CM, Levin R, Stevenson LW. Hospice, opiates, and acute care service use among the elderly before death from heart failure or cancer. Am Heart J. 2010;160:139–44. [PMC free article] [PubMed]
Stockl KM, Le L, Zhang S, Harada AS. Clinical and economic outcomes associated with potentially inappropriate prescribing in the elderly. Am J Manag Care. 2010;16:e1–10. [PubMed]
Tjia J, Rothman MR, Kiely DK, et al. Daily medication use in nursing home residents with advanced dementia. J Am Geriatr Soc. 2010;58:880–8. [PMC free article] [PubMed]
Ulfvarson J, Rahmner PB, Fastbom J, Sjöviker S, Karlsson EA. Medication reviews with computerised expert support: evaluation of a method to improve the quality of drug utilisation in the elderly. Int J Health Care Qual Assur. 2010;23:571–82. [PubMed]
van der Linden CM, Jansen PA, van Geerenstein EV, et al. Reasons for discontinuation of medication during hospitalization and documentation thereof: a descriptive study of 400 geriatric and internal medicine patients. Arch Intern Med. 2010;170:1085–7. [PubMed]
Walling AM, Asch SM, Lorenz KA, et al. The quality of care provided to hospitalized patients at the end of life. Arch Intern Med. 2010;170:1057–63. [PMC free article] [PubMed]
Weinstock RS, Izquierdo R, Goland R, et al. Lipid treatment in ethnically diverse underserved older adults with diabetes mellitus: statin use, goal attainment, and health disparities in the informatics for diabetes education and telemedicine project. J Am Geriatr Soc. 2010;58:401–2. [PubMed]
Williams BA, Baillargeon JG, Lindquist K, et al. Medication prescribing practices for older prisoners in the Texas prison system. Am J Public Health. 2010;100:756–61. [PubMed]
Tjia J, Field TS, Garber LD, et al. Development and pilot testing of guidelines to monitor high-risk medications in the ambulatory setting. Am J Manag Care. 2010;16:489–96. [PubMed]

Medication administration

Poon EG, Keohane CA, Yoon CS, et al. Effect of bar-code technology on the safety of medication administration. N Engl J Med. 2010;362:1698–707. [PubMed]
Verrue CL, Mehuys E, Somers A, Van Maele G, Remon JP, Petrovic M. Medication administration in nursing homes: pharmacists’ contribution to error prevention. J Am Med Dir Assoc. 2010;11:275–83. [PubMed]
Westbrook JI, Woods A, Rob MI, Dunsmuir WTM, Day RO. Association of interruptions with an increased risk and severity of medication administration errors. Arch Intern Med. 2010;170:683–90. [PubMed]

Medication adherence

Berry SD, Quach L, Procter-Gray E, et al. Poor adherence to medications may be associated with falls. J Gerontol A Biol Sci Med Sci. 2010;65:553–8. [PMC free article] [PubMed]
Bozek A, Jarzab J. Adherence to asthma therapy in elderly patients. J Asthma. 2010;47:162–5. [PubMed]
Briesacher BA, Andrade SE, Harrold LR, Fouayzi H, Yood RA. Adherence and occurrence of fractures after switching to once-monthly oral bisphosphonates. Pharmacoepidemiol Drug Saf. 2010;19:1233–40. [PMC free article] [PubMed]
Briesacher BA, Andrade SE, Harrold LR, Fouayzi H, Yood RA. Adoption of once-monthly oral bisphosphonates and the impact on adherence. Am J Med. 2010;120:275–80. [PMC free article] [PubMed]
Castaldi PJ, Rogers WH, Safran DG, Wilson IB. Inhaler costs and medication nonadherence among seniors with chronic pulmonary disease. Chest. 2010;138:614–20. [PubMed]
Duru OK, Mangione CM, Hsu J, et al. Generic-only drug coverage in the Medicare Part D gap and effect on medication cost-cutting behaviors for patients with diabetes mellitus: the translating research into action for diabetes study. J Am Geriatr Soc. 2010;58:822–8. [PMC free article] [PubMed]
Friedman O, McAlister FA, Yun L, et al. Antihypertensive drug persistence and compliance among newly treated elderly hypertensives in Ontario. Am J Med. 2010;123:173–81. [PubMed]
Pariente A, Pinet M, Moride Y, Merliére Y, Moore N, Fourrier-Réglat A. Factors associated with persistence of cholinesterase inhibitor treatments in the elderly. Pharmacoepidemiol Drug Saf. 2010;19:680–6. [PubMed]
Rifkin DE, Laws MB, Rao M, Balakrishnan VS, Sarnak MJ, Wilson IB. Medication adherence behavior and priorities among older adults with CKD: a semistructured interview study. Am J Kidney Dis. 2010;56:439–46. [PMC free article] [PubMed]
Russell CL, Cetingok M, Hamburger KQ, et al. Medication adherence in older renal transplant recipients. Clin Nurs Res. 2010;19:95–112. [PubMed]
Setoguchi S, Choudhry NK, Levin R, Shrank WH, Winkelmayer WC. Temporal trends in adherence to cardiovascular medications in elderly patients after hospitalization for heart failure. Clin Pharmacol Ther. 2010;88:548–54. [PubMed]
Zivin K, Ratliff S, Heisler MM, Langa KM, Piette JD. Factors influencing cost-related nonadherence to medication in older adults: a conceptually based approach. Value Health. 2010;13:338–45. [PMC free article] [PubMed]

Drug monitoring

Gouin-Thibault I, Levy C, Pautas E, et al. Improving anticoagulation control in hospitalized elderly patients on warfarin. J Am Geriatr Soc. 2010;58:242–7. [PubMed]
Kales HC, Kim HM, Austin KL, Valenstein M. Who receives outpatient monitoring during high-risk depression treatment periods? J Am Geriatr Soc. 2010;58:908–13. [PMC free article] [PubMed]
Roberts GW, Farmer CJ, Cheney PC, et al. Clinical decision support implemented with academic detailing improves prescribing of key renally cleared drugs in the hospital setting. J Am Med Inform Assoc. 2010;17:308–12. [PMC free article] [PubMed]

MEDICATION ADVERSE EVENTS

Buckeridge D, Huang A, Hanley J, et al. Risk of injury associated with opioid use in older adults. J Am Geriatr Soc. 2010;58:1664–70. [PubMed]
Caughey GE, Roughead EE, Pratt N, Shakib S, Vitry AI, Gilbert AL. Increased risk of hip fracture in the elderly associated with prochlorperazine: is a prescribing cascade contributing? Pharmacoepidemiol Drug Saf. 2010;19:977–82. [PubMed]
Dublin S, Walker RL, Jackson ML, Nelson JC, Weiss NS, Jackson LA. Use of proton pump inhibitors and H2 blockers and risk of pneumonia in older adults: a population-based case-control study. Pharmacoepidemiol Drug Saf. 2010;19:792–802. [PMC free article] [PubMed]
Garcia-Caballos M, Ramos-Diaz F, Jimenez-Moleon JJ, Bueno-Cavanillas A. Drug-related problems in older people after hospital discharge and interventions to reduce them. Age Ageing. 2010;39:430–8. [PubMed]
Graham DJ, Ouellet-Hellstrom R, MaCurdy TE, et al. Risk of acute myocardial infarction, stroke, heart failure, and death in elderly Medicare patients treated with rosiglitazone or pioglitazone. JAMA. 2010;304:411–8. [PubMed]
Ho JM, Juurlink DN, Cavalcanti RB. Hypokalemia following polyethylene glycol-based bowel preparation for colonoscopy in older hospitalized patients with significant comorbidities. Ann Pharmacother. 2010;44:466–70. [PubMed]
Jalbert JJ, Eaton CB, Miller SC, Lapane KL. Antipsychotic use and the risk of hip fracture among older adults afflicted with dementia. J Am Med Dir Assoc. 2010;11:120–7. [PubMed]
Leendertse AJ, Visser D, Egberts AC, van den Bemt PM. The relationship between study characteristics and the prevalence of medication-related hospitalizations: a literature review and novel analysis. Drug Saf. 2010;33:233–44. [PubMed]
Kamaruzzaman S, Watt H, Carson C, Ebrahim S. The association between orthostatic hypotension and medication use in the British Women’s Heart and Health Study. Age Ageing. 2010;39:51–6. [PubMed]
Lai SW, Liao KF, Liao CC, Muo CH, Liu CS, Sung FC. Polypharmacy correlates with increased risk for hip fracture in the elderly: a population-based study. Medicine. 2010;89:295–9. [PubMed]
Makris UE, Kohler MJ, Fraenkel L. Adverse effects of topical nonsteroidal antiinflammatory drugs in older adults with osteoarthritis: a systematic literature review. J Rheumatol. 2010;37:1236–43. [PMC free article] [PubMed]
Mehta S, Johnson ML, Chen H, Aparasu RR. Risk of cerebrovascular adverse events in older adults using antipsychotic agents: a propensity-matched retrospective cohort study. J Clin Psychiatry. 2010;71:689–98. [PubMed]
Onder G, Petrovic M, Tangiisuran B, et al. Development and validation of a score to assess risk of adverse drug reactions among in-hospital patients 65 years or older: the GerontoNet ADR risk score. Arch Intern Med. 2010;170:1142–8. [PubMed]
Pratt N, Roughead EE, Ryan P, Gilbert AL. Differential impact of NSAIDs on rate of adverse events that require hospitalization in high-risk and general veteran populations: a retrospective cohort study. Drugs Aging. 2010;27:63–71. [PubMed]
Sneed JR, Culang ME, Keilp JG, Rutherford BR, Devanand DP, Roose SP. Antidepressant medication and executive dysfunction: a deleterious interaction in late-life depression. Am J Geriatr Psychiatry. 2010;18:128–35. [PMC free article] [PubMed]
Solomon DH, Rassen JA, Glynn RJ, Lee J, Levin J, Schneeweiss S. The comparative safety of analgesics in older adults with arthritis. Arch Intern Med. 2010;170:1968–76. [PubMed]
Solomon DH, Rassen JA, Glynn RJ, et al. The comparative safety of opioids for nonmalignant pain in older adults. Arch Intern Med. 2010;170:1979–86. [PubMed]
Somers A, Robays H, Vander Stichele R, Van Maele G, Bogaert M, Petrovic M. Contribution of drug related problems to hospital admission in the elderly. J Nutr Health Aging. 2010;14:477–82. [PubMed]
Teramura-Grönblad M, Hosia-Randell H, Muurinen S, Pitkala K. Use of proton-pump inhibitors and their associated risks among frail elderly nursing home residents. Scand J Prim Health Care. 2010;28:154–9. [PMC free article] [PubMed]
Trifirò G, Gambassi G, Sen EF, et al. Association of community-acquired pneumonia with antipsychotic drug use in elderly patients: a nested case-control study. Ann Intern Med. 2010;152:418–25. [PubMed]

* Excludes those previously published in the American Journal of Geriatric Pharmacotherapy or by one of the authors

References

1. Handler SM, Wright RM, Ruby CM, Hanlon JT. Epidemiology of medication-related adverse events in nursing homes. Am J Geriatr Pharmacother. 2006;4:264–272. [PubMed]

2. Hanlon JT, Handler S, Maher R, Schmader KE. Geriatric Pharmacotherapy and Polypharmacy. In: Fillit H, Rockwood K, Woodhouse K, editors. Brocklehurst’s Textbook of Geriatric Medicine. 7. London, UK: Churchill Livingstone; 2010. pp. 880–885.

3. Beijer HJ, de Blaey CJ. Hospitalisations caused by adverse drug reactions (ADR): a meta-analysis of observational studies. Pharm World Sci. 2002;24:46–54. [PubMed]

4. Tulner LR, van Campen JP, Frankfort SV, et al. Changes in under-treatment after comprehensive geriatric assessment: an observational study. Drugs Aging. 2010;27:831–43. [PubMed]

5. Wright RM, Sloane RJ, Pieper CF, Ruby-Scelsi CM, Twersky J, Schmader KE, Hanlon JT. Underuse of indicated medications among physically frail older US veterans at the time of hospital discharge. Am J Geriatr Pharmacother. 2009;7:271–280. [PMC free article] [PubMed]

6. Schmader KE, Hanlon JT, Pieper CF, et al. Effects of geriatric evaluation and management on adverse drug reactions and suboptimal prescribing in the frail elderly. Am J Med. 2004;116:394–401. [PubMed]

7. Mattison ML, Afonso KA, Ngo LH, Mukamal KJ. Preventing potentially inappropriate medication use in hospitalized older patients with a computerized provider order entry warning system. Arch Intern Med. 2010;170:1331–6. [PubMed]

8. Fick DM, Cooper JW, Wade WE, Waller JL, Maclean JR, Beers MH. Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med. 2003;163:2716–24. [PubMed]

9. Yourman L, Concato J, Agostini JV. Use of computer decision support interventions to improve medication prescribing in older adults: a systematic review. Am J Geriatr Pharmacother. 2008;6:119–29. [PubMed]

10. Page RL, 2nd, Linnebur SA, Bryant LL, Ruscin JM. Inappropriate prescribing in the hospitalized elderly patient: defining the problem, evaluation tools, and possible solutions. Clin Interv Aging. 2010;5:75–87. [PMC free article] [PubMed]

11. Krousel-Wood MA, Muntner P, Joyce CJ, et al. Adverse effects of complementary and alternative medicine on antihypertensive medication adherence: findings from the cohort study of medication adherence among older adults. J Am Geriatr Soc. 2010;58:54–61. [PMC free article] [PubMed]

12. Lengacher C, Bennett MP, Kipp KE, et al. Design and testing of the use of a complementary and alternative therapies survey in women with breast cancer. Oncol Nurs Forum. 2003;30:811–21. [PubMed]

13. Morisky DE, Ang A, Krousel-Wood, et al. Predictive validity of a medication adherence measure in an outpatient setting. J Clin Hypertens. 2008;10:348–54. [PMC free article] [PubMed]

14. Krousel-Wood MA, Islam T, Webber LS, et al. New medication adherence scale versus pharmacy fill rates in hypertensive seniors. Am J Manag Care. 2009;15:59–66. [PMC free article] [PubMed]

15. Hanlon JT, Blackman MR, Glick RM. Complementary and Alternative Medicine. In: Halter JB, et al., editors. Hazzard‘s Geriatric Medicine and Gerontology. 6. 2009. pp. 303–308.

16. Golden AG, Ma Q, Nair V, Florez HJ, Roos BA. Risk for fractures with centrally acting muscle relaxants: an analysis of a national Medicare Advantage claims database. Ann Pharmacother. 2010;44:1369–75. [PubMed]

17. Fink H, Wyman J, Hanlon JT. Falls. In: Tallis R, Fillit H, editors. Brocklehurst’s Textbook of Geriatric Medicine. 6. London, UK: Churchill Livingstone; 2003. pp. 1337–46.

18. Aizenberg D, Sigler M, Weizman A, Barak Y. Anticholinergic burden and the risk of falls among elderly psychiatric inpatients: a 4-year case-control study. Intern Psychogeriatr. 2002;14:307–10. [PubMed]

19. Berdot S, Bertrand M, Dartigues JF, Fourrier A, Tavernier B, Ritchie KL, Alpérovitch A. Inappropriate medication use and risk of falls – A prospective study in a large community-dwelling elderly cohort. BMC Geriatrics. 2009;9:30. [PMC free article] [PubMed]

20. Hanlon JT, Boudreau RM, Roumani YF, Newman AB, Ruby CM, Wright RM, Hilmer SN, Shorr RI, Bauer DC, Simonsick EM, Studenski SA. Number and dosage of central nervous system medications on recurrent falls in community elders: the Health, Aging and Body Composition study. J Gerontol Med Sci. 2009;64A(4):492–498. [PMC free article] [PubMed]

21. Ray WA, Griffen MR, Fought RL, Adams ML. Identification of fractures from computerized Medicare Files. J Clin Epidemiol. 1992;45:703–714. [PubMed]

22. Fox KM, Reuland M, Hawkes WG, et al. Accuracy of medical records in hip fracture. J Am Geriatr Soc. 1998;46:745–50. [PubMed]

23. Trivalle C, Cartier T, Verny C, et al. for the IMEPAG GROUP. Identifying and preventing adverse drug events in elderly hospitalised patients: a randomised trial of a program to reduce adverse drug effects. J Nutr Health Aging. 2010;14:57–61. [PubMed]

24. Hanlon JT, Weinberger M, Samsa GP, et al. A randomized, controlled trial of a clinical pharmacist intervention to improve inappropriate prescribing in elderly outpatients with polypharmacy. Am J Med. 1996;100:428–37. [PubMed]

25. Schmader KE, Hanlon JT, Pieper CF, et al. Effectiveness of geriatric evaluation and management on adverse drug reactions and suboptimal prescribing in the frail elderly. Am J Med. 2004;116:394–401. [PubMed]

26. Crotty M, Halbert J, Rowett D, et al. An outreach geriatric medication advisory service in residential aged care: a randomised controlled trial of case conferencing. Age Ageing. 2004;33:612–7. [PubMed]

27. Gurwitz JH, Field TS, Rochon P, et al. Effect of computerized provider order entry with clinical decision support on adverse drug events in the long-term care setting. J Am Geriatr Soc. 2008;56:2225–33. [PubMed]

28. Naranjo CA, Busto U, Sellers EM, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981;30:239–45. [PubMed]