International Journal of Clinical Pharmacy

, Volume 38, Issue 2, pp 462–468 | Cite as

Potentially inappropriate drug prescribing in elderly hospitalized patients: an analysis and comparison of explicit criteria

  • Concetta Di GiorgioEmail author
  • Alessio Provenzani
  • Piera Polidori
Research Article


Background The management of therapy in elderly is a critical aspect of primary care. The physio-pathological complexity of the elderly involves the prescription of multiple drugs, exposing them to a higher risk of adverse reactions. Objective Aim of this study was to assess the medication use and (potential) inappropriate medications and prescribing omissions in the elderly before and during hospitalization, according to the main tools in literature described, and their relation to the number of comorbidities. Setting The study was carried out by the Clinical Pharmacists at ISMETT, an Italian Research Institute. Methods The prescriptions of elderly, admitted in ISMETT between January and December 2012, were analyzed. The information about clinical profile of elderly and prescriptions was obtained from the electronic medical records. 2012 Beers criteria, Screening Tool of Older Person’s Prescriptions/Screening Tool to Alert doctors to Right Treatment criteria, and Improving Prescribing in the Elderly criteria were used to evaluate the appropriateness of prescriptions. The correlation between the number of comorbidities and the different tools was analyzed with the Spearman correlation coefficient. The frequency analysis was done with the Pearson Chi square test. Main outcome measure Percentage of potentially inappropriate medications and prescribing omissions before/during hospitalization in elderly. Results 1027 elderly were admitted between January and December 2012. At admission and during hospitalization, according to Beers criteria 24 and 49 % of elderly had at least one potentially inappropriate medication, respectively; according to the Screening Tool of Older Person’s Prescriptions criteria 21 and 27 %, respectively; according to the Improving Prescribing in the Elderly criteria 28 and 25 %, respectively; and then, according to Screening Tool to Alert doctors to Right Treatment criteria 28 and 33 % had at least one potentially prescribing omission, respectively. A significant correlation between comorbidities number and potentially inappropriate medications was found. Conclusion The number of potentially inappropriate medications globally increased during hospitalization. Statistical analysis showed that the comorbidity affects the level of inappropriate prescriptions. Specific tools can guide clinicians toward a more rational use of medicines and minimize probable complications related to multi-treatments.


Aging Drug utilisation Drug–drug interactions Elderly Hospital Italy Medicine use Polypharmacy Prescribing appropriateness index Safety Utilisation evaluation 



The authors thank Warren Blumberg, Science editor at IRCSS-ISMETT for his help in editing this paper.


No funding was received for this study.

Conflicts of interest

The authors of this manuscript do not have any conflicts of interest relating to this publication.


  1. 1.
    Mangoni AA, Jackson SH. Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications. Br J Clin Pharmacol. 2004;57(1):6–14.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Hubbard RE, O’Mahony MS, Woodhouse KW. Medication prescribing in frail older people. Eur J Clin Pharmacol. 2013;69(3):319–26.CrossRefPubMedGoogle Scholar
  3. 3.
    Hilmer SN, McLachlan AJ, Le Couteur DG. Clinical pharmacology in the geriatric patient. Fundam Clin Pharmacol. 2007;21(3):217–30.CrossRefPubMedGoogle Scholar
  4. 4.
    L’uso dei farmaci in Italia. Rapporto nazionale anno 2013. Last accessed 2015 June 29.
  5. 5.
    Ruggiero C, Dell’Aquila G, Gasperini B, Onder G, Lattanzio F, Volpato S, et al. Potentially inappropriate drug prescriptions and risk of hospitalization among older, Italian, nursing home residents: the ULISSE project. Drugs Aging. 2010;27(9):747–58.CrossRefPubMedGoogle Scholar
  6. 6.
    Fialová D, Topinková E, Gambassi G, Finne-Soveri H, Jónsson PV, Carpenter I, et al. Potentially inappropriate medication use among elderly home care patients in Europe. JAMA. 2005;293(11):1348–58.CrossRefPubMedGoogle Scholar
  7. 7.
    Studio nazionale dell’Agenzia Italiana del Farmaco sulla qualità della prescrizione farmacologica nella popolazione geriatrica. Last accessed 2015 June 29.
  8. 8.
    American Geriatrics Society 2012 Beers Criteria Update Expert Panel. American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2012;60(4):616–31.CrossRefGoogle Scholar
  9. 9.
    Gallagher P, Ryan C, Byrne S, Kennedy J, O’Mahony D. STOPP (screening tool of older person’s prescriptions) and START (screening tool to alert doctors to right treatment). Consensus validation. Int J Clin Pharmacol Ther. 2008;46(2):72–83.CrossRefPubMedGoogle Scholar
  10. 10.
    Barry PJ, Gallagher P, Ryan C, O’mahony D. START (screening tool to alert doctors to the right treatment)–an evidence-based screening tool to detect prescribing omissions in elderly patients. Age Ageing. 2007;36(6):632–8.CrossRefPubMedGoogle Scholar
  11. 11.
    Naugler CT, Brymer C, Stolee P, Arcese ZA. Development and validation of an improving prescribing in the elderly tool. Can J Clin Pharmacol. 2000;7(2):103–7.PubMedGoogle Scholar
  12. 12.
    Düngen HD, Apostolovic S, Inkrot S, Tahirovic E, Töpper A, Mehrhof F, et al. Titration to target dose of bisoprolol vs. carvedilol in elderly patients with heart failure: the CIBIS-ELD trial. Eur J Heart Fail. 2011;13(6):670–80.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Casucci I, Provenzani A, Polidori P. Evaluation of treatment of invasive fungal infections. J Pharmacol Pharmacother. 2014;5(1):47–52.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Venuti F, Panarello G, Gruttadauria S, Burgio G, Di Stefano R, Provenzani A, et al. Selective decontamination of the digestive tract in adult-to-adult living related liver transplant patients: a single centre experience. Int J Antimicrob Agents. 2008;31(5):486–7.CrossRefPubMedGoogle Scholar
  15. 15.
    Onder G, van der Cammen TJ, Petrovic M, Somers A, Rajkumar C. Strategies to reduce the risk of iatrogenic illness in complex older adults. Age Ageing. 2013;42(3):284–91.CrossRefPubMedGoogle Scholar
  16. 16.
    Patterson SM, Cadogan CA, Kerse N, Cardwell CR, Bradley MC, Ryan C, et al. Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database Syst Rev. 2014;10:CD008165.PubMedGoogle Scholar
  17. 17.
    Tjia J, Velten SJ, Parsons C, Valluri S, Briesacher BA. Studies to reduce unnecessary medication use in frail older adults: a systematic review. Drugs Aging. 2013;30(5):285–307.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing 2016

Authors and Affiliations

  • Concetta Di Giorgio
    • 1
    Email author
  • Alessio Provenzani
    • 1
  • Piera Polidori
    • 1
  1. 1.ISMETTPalermoItaly

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