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Drug prescription appropriateness in the elderly: an Italian study

Authors Allegri N, Rossi F, Del Signore F, Bertazzoni P, Bellazzi R, Sandrini G, Vecchi T, Liccione D, Pascale A, Govoni S

Received 24 March 2016

Accepted for publication 8 July 2016

Published 10 February 2017 Volume 2017:12 Pages 325—333

DOI https://doi.org/10.2147/CIA.S109125

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Supriya Swarnkar

Peer reviewer comments 2

Editor who approved publication: Dr Richard Walker


Nicola Allegri,1 Federica Rossi,2 Federica Del Signore,2 Paolo Bertazzoni,3 Roberto Bellazzi,4 Giorgio Sandrini,5 Tomaso Vecchi,1 Davide Liccione,1 Alessia Pascale,6 Stefano Govoni6

1Department of Brain and Behavioral Sciences, University of Pavia, 2Pavia and Vigevano Neuropsychological Center for Alzheimer’s Disease, 3”Bertazzoni” Pharmacy General Partnership, Vigevano, 4Nephrology and Dialysis Ward, Civil Hospital of Vigevano, 5C. Mondino National Institute of Neurology Foundation, IRCCS, 6Department of Drug Sciences, Section of pharmacology, University of Pavia, Pavia, Italy


Purpose: Correct drug prescription in the elderly is a difficult task that requires careful survey of the current pharmacological therapies. In this article, we reviewed the drug prescriptions provided to 860 persons aged 65 years or over, residing in a small city of Lombardy, Italy.
Methods: Subjects were recruited from a local nursing home, the Pavia and Vigevano Neuropsychological Center for Alzheimer’s Disease, general practitioners’ offices, and the local University of the Third Age. For each patient, the amount of potentially inappropriate prescriptions (PIPs), sedative and anticholinergic load (SL and AL, respectively), and drug–drug interactions were evaluated.
Results: Widespread polypharmacy, giving rise to 10.06% of PIPs in the whole collection of prescriptions, was observed. In particular, PIPs mainly concern drugs acting at the central nervous system level, mostly benzodiazepines and antipsychotics. Moreover, approximately one-fourth of the subjects had an elevated SL and approximately one-tenth a high AL. Drug–drug interactions were frequent (266 requiring medical attention), up to five for each single patient. Of concern was the underuse of antidementia drugs: only 20 patients received a cholinesterase inhibitor or memantine, although 183 patients were potentially suitable for this treatment.
Conclusion: These results demonstrate the need to develop novel strategies aimed at improving the quality of drug prescription.

Keywords: drug prescription, elderly, Beers criteria, drug–drug interactions, sedative load
 
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