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Potentially inappropriate prescribing in a population of frail elderly people

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Abstract

Background Frailty is a clinical syndrome highly predictive of functional decline after a stress or a medical event, such as adverse drug events. Objective To describe the prevalence of potentially inappropriate prescribing in a population of frail elderly patients. Setting Geriatric day hospital for assessment of frailty and prevention of disability, Toulouse, France. Method A cross-sectional study performed from January to April 2014. Two pharmacists retrospectively analyzed the prescriptions of elderly patients who were sent to the day hospital to assess their frailty and to be given a personalized plan of care and prevention. Potentially inappropriate prescribing was defined by combining explicit criteria: Laroche list, screening tool of older people’s prescriptions, and screening tool to alert to right treatment with an implicit method (drug utilization review for each medication). Prescriptions’ optimizations were then suggested to the geriatricians of the day hospital and classified according to criteria defined by the French Society of Clinical Pharmacy. Main outcome measure Prevalence of potentially inappropriate prescribing. Results Among the 229 patients included, 71.2% had potentially inappropriate prescribing. 76 patients (33.2%) had at least one drug without any valid indication. 51 (22.3%) had at least one drug with an unfavorable benefit-to-risk ratio according to their clinical and biological data, 42 (18.3%) according to the Laroche list and 38 (16.6%) had at least one drug with questionable efficacy. Conclusion Our work shows that the incidence of PIP is high in the frail elderly and that, in most cases, it could be avoided with an adequate and regular reassessment of the prescriptions. In future, prescription optimization will be integrated into the personalized medical care plan to further prevent drug-related disability.

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Acknowledgements

We would like to thank members of the team of the “geriatric frailty clinic for assessment of frailty and prevention of disability”.

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Authors and Affiliations

  1. Department of Pharmacy, Centre Hospitalier Universitaire de Toulouse, Cité de la Santé, 20 Rue du Pont Saint-Pierre, TSA 60033, 31059, Toulouse Cedex 9, France

    Isabelle Récoché, Cécile Lebaudy, Charlène Cool & Philippe Cestac

  2. UMR INSERM 1027, University of Toulouse III, 37 Allée Jules Guesde, 31000, Toulouse, France

    Charlène Cool, Sandrine Sourdet, Maryse Lapeyre-Mestre, Bruno Vellas & Philippe Cestac

  3. Department of Geriatric Medicine University Hospital, Cité de la Santé, 20 Rue du Pont Saint-Pierre, TSA 60033, 31059, Toulouse Cedex 9, France

    Sandrine Sourdet, Antoine Piau & Bruno Vellas

  4. Department of Pharmacology, University Hospital, 37 Allée Jules Guesde, 31000, Toulouse, France

    Maryse Lapeyre-Mestre

Authors
  1. Isabelle Récoché
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  2. Cécile Lebaudy
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  3. Charlène Cool
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  4. Sandrine Sourdet
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  5. Antoine Piau
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  6. Maryse Lapeyre-Mestre
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  7. Bruno Vellas
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  8. Philippe Cestac
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Corresponding authors

Correspondence to Isabelle Récoché or Cécile Lebaudy.

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Conflicts of interest

Bruno Vellas is a Scientific Board Member of Biogen, GSK, Lilly, Lundbeck, Medivation, MSD, Nestlé, Nutricia, Pfizer, Roche, Sanofi, Servier, TauRx Therapeutics, Alzhéon, Transition Therapeutics, Takeda and received Gerontopôle Research Grants from Abbvie, Affiris, Avid, BMS, Eisai, Elan, Envivo, Exhonit, Genentech, GSK, Ipsen, Lilly, Lundbeck, Médivation, MSD, Nutricia, Otsuka, Pharnext, Pfizer, Pierre-Fabre, Régénéron, Roche, Sanofi, Servier, TauRx Therapeutics, Wyeth, Astra-Zénéca, LPG Systems. All the others authors have no conflict of interest to declare.

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Récoché, I., Lebaudy, C., Cool, C. et al. Potentially inappropriate prescribing in a population of frail elderly people. Int J Clin Pharm 39, 113–119 (2017). https://doi.org/10.1007/s11096-016-0406-2

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  • DOI: https://doi.org/10.1007/s11096-016-0406-2

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