Inappropriate medication prescribing for elderly ambulatory care patients

Arch Intern Med. 2004 Feb 9;164(3):305-12. doi: 10.1001/archinte.164.3.305.


Background: Inappropriate medication use in elderly patients has been linked to a large share of adverse drug reactions and to excess health care utilization.

Methods: Trends in the prevalence of potentially inappropriate drug prescribing at ambulatory care visits by elderly persons from 1995 to 2000 were examined with data from office-based physicians in the National Ambulatory Medical Care Survey and from hospital outpatient departments in the National Hospital Ambulatory Medical Care Survey. Explicit criteria were used to identify potentially inappropriate prescribing. Multivariate regression was used to identify related factors.

Results: In 1995 and 2000, at least 1 drug considered inappropriate by the Beers expert panel was prescribed at 7.8% of ambulatory care visits by elderly patients. At least 1 drug classified as never or rarely appropriate by the Zhan expert panel was prescribed at 3.7% and 3.8% of these visits in 1995 and 2000, respectively. Pain relievers and central nervous system drugs were a large share of the problem. The odds of potentially inappropriate prescribing were higher for visits with multiple drugs and double for female visits. The latter was due to more prescribing of potentially inappropriate pain relievers and central nervous system drugs.

Conclusions: Potentially inappropriate prescribing at ambulatory care visits by elderly patients, particularly women, remains a substantial problem. Interventions could target more appropriate drug selection by physicians when prescribing pain relievers, antianxiety agents, sedatives, and antidepressants to elderly patients. Such behavior could eliminate a large portion of inappropriate prescribing for elderly patients and reduce its higher risk for women.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Ambulatory Care* / trends
  • Analgesics, Opioid / adverse effects
  • Analgesics, Opioid / therapeutic use
  • Antidepressive Agents / adverse effects
  • Antidepressive Agents / therapeutic use
  • Anxiety / drug therapy
  • Central Nervous System Agents / adverse effects
  • Central Nervous System Agents / therapeutic use
  • Cross-Sectional Studies
  • Depression / drug therapy
  • Drug Prescriptions*
  • Female
  • Health Care Surveys
  • Humans
  • Male
  • Medication Errors / prevention & control
  • Medication Errors / statistics & numerical data
  • Medication Errors / trends*
  • Middle Aged
  • Multivariate Analysis
  • Office Visits / statistics & numerical data
  • Office Visits / trends
  • Outpatient Clinics, Hospital / statistics & numerical data
  • Outpatient Clinics, Hospital / trends
  • Pain / drug therapy
  • Physician-Patient Relations
  • Physicians, Family / statistics & numerical data
  • Physicians, Family / trends
  • Practice Patterns, Physicians' / statistics & numerical data
  • Prevalence
  • Quality of Health Care
  • Random Allocation
  • Statistics as Topic
  • United States / epidemiology


  • Analgesics, Opioid
  • Antidepressive Agents
  • Central Nervous System Agents