INAPPROPRIATE PRESCRIBING LINKED TO INCREASED RISK TO NURSING HOME PATIENTS

A research study published in the January 10, 2005 Archives of Internal Medicine has linked the prescribing of drugs that should be avoided in the elderly because their known dangers to an increased risk of death and hospitalization.  

An elderly patient’s risk of hospitalization was almost 30% higher in those who received one of the inappropriate drugs during the preceding month.   The risk of death during any month of the study was 21% higher in patients who were prescribed one of the inappropriate drugs during the month of death or the preceding month, compared to patients who were not prescribed one of the dangerous drugs.

The five most common drugs that should not have been prescribed to this group of patients were the antidepressant amitriptyline (ELAVIL), the antihistamines that are sometimes inappropriately prescribed for the elderly as sleeping pills diphenhydramine (BENADRYL) and hydroxyzine (ATARAX, VISTARIL), oxybutynin (DITROPAN, DITROPAN XL) used for urinary incontinence, and the dangerous painkiller propoxyphene (DARVON).

These drugs appear on a list developed in 1991 that was used to study inappropriate prescribing in nursing home residents.   These drugs are sometimes referred to as the Beers drugs or the Beers criteria after the main author of the 1991 study.  The list of drugs has been updated twice since 1991, most recently in 2002.

Both amitriptyline and propoxyphene are listed as DO NOT USE drugs in the new edition of Worst Pills, Best Pills.   For the other three drugs, diphenhydramine, hydroxyzine, and oxybutynin, strong warning are given about using these drugs in elderly patients.

This study uderscrores the risks faced by elderly nursing home residents from inappropriate prescribing.