Drugs & Aging

, Volume 22, Issue 7, pp 559–569 | Cite as

Medication-Related Problems in the Elderly

Defining the Issues and Identifying Solutions
  • William Simonson
  • Janice L. Feinberg
Leading Article


The elderly population is at great risk for medication-related problems as a result of age-related physiological changes, the presence of multiple chronic diseases and conditions, and the types and numbers of prescription and nonprescription medications they consume.

Medication-related problems have received international attention. In the US, as many as 200 000 people may die of medication-related problems each year. Studies from other developed nations where patients have access to medications have determined that various types of medication-related problems occur in the elderly population in healthcare environments ranging from nursing homes to community dwelling settings.

A variety of initiatives have been developed in an attempt to reduce the likelihood of medication-related problems in the elderly. The role that a pharmacist can play in identifying and preventing the negative health outcomes and costs of medication-related problems is being increasingly recognised. Indeed, numerous studies have now documented the positive impact that pharmacists can have in this area, and ongoing research is being conducted.

With the growing numbers of elderly, and the increase in the numbers and types of medications available, it is imperative that awareness of medication-related problems be increased and that further initiatives be developed to optimise the positive outcomes of drug therapy in the elderly.


Nursing Home Adverse Drug Event Pharmaceutical Care Inappropriate Medication Medication List 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



No sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of this review.


  1. 1.
    Cameron KA. Preventing medication-related problems among older Americans. Manag Care Interface 1998; 11(10): 74–6PubMedGoogle Scholar
  2. 2.
    Avorn J. Medication use and the elderly: current status and opportunities. Health Aff (Millwood) 1995 Spring; 14(1): 276–86CrossRefGoogle Scholar
  3. 3.
    Gurwitz J, Monane M, Monane S, et al. Long-term care quality letter. Providence (RI): Brown University, 1995Google Scholar
  4. 4.
    Knight EL, Avorn J. Quality indicators for appropriate medication use in vulnerable elders. Ann Intern Med 2001; 135: 703–10PubMedGoogle Scholar
  5. 5.
    Cipolle RJ, Strand LM, Morley PC. Pharmaceutical care practice. New York: McGraw-Hill, 1998Google Scholar
  6. 6.
    Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm 1990; 47: 533–43PubMedGoogle Scholar
  7. 7.
    Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA 1998; 279: 1200–5PubMedCrossRefGoogle Scholar
  8. 8.
    Gurwitz JH, Field TS, Avorn J, et al. Incidence and preventability of adverse drug events in nursing homes. Am J Med 2000; 109(2): 87–94PubMedCrossRefGoogle Scholar
  9. 9.
    American Society of Consultant Pharmacists. ASCP’s prescription for quality care: preventing medication-related problems among America’s seniors. Alexandria (VA): American Society of Consultant Pharmacists, 2000: 1–16Google Scholar
  10. 10.
    Fu AZ, Liu GG, Christensen DB. Inappropriate medication use and health outcomes in the elderly. J Am Geriatr Soc 2004; 52: 1934–9PubMedCrossRefGoogle Scholar
  11. 11.
    Hajjar ER, Hanlon JT, Artz MB, et al. Adverse drug reaction risk factors in older outpatients. Am J Geriatr Pharmacother 2003 Dec; 1(2): 82–9PubMedCrossRefGoogle Scholar
  12. 12.
    Gurwitz JH, Field TS, Harrold LR, et al. Incidence and prevent-ability of adverse drug events among older persons in the ambulatory setting. JAMA 2003; 289: 1107–16PubMedCrossRefGoogle Scholar
  13. 13.
    Dhall J, Larrat EP, Lapane KL. Use of potentially inappropriate drugs in nursing facilities. Pharmacotherapy 2002; 22: 88–96PubMedCrossRefGoogle Scholar
  14. 14.
    Liu GG, Christensen DB. The continuing challenge of inappropriate prescribing in the elderly: an update of the evidence. J Am Pharm Assoc (Wash) 2002; 42: 847–57CrossRefGoogle Scholar
  15. 15.
    Beers MH, Ouslander JG, Rollingher I, et al. Explicit criteria for determining inappropriate medication use in nursing home residents: UCLA Division of Geriatric Medicine. Arch Intern Med 1991; 151: 1825–32PubMedCrossRefGoogle Scholar
  16. 16.
    Beers MH. Explicit criteria for determining potentially inappropriate medication use by the elderly. Arch Intern Med 1997; 157: 1531–6PubMedCrossRefGoogle Scholar
  17. 17.
    Fick DM, Cooper JW, Wade WE, et al. Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts [published erratum appears in Arch Intern Med 2004; 164 (3): 298]. Arch Intern Med 2003; 163(22): 2716–24PubMedCrossRefGoogle Scholar
  18. 18.
    McLeod PJ, Huang AR, Tamblyn RM, et al. Defining inappropriate practices in prescribing for elderly people: a national consensus panel. CMAJ 1997 Jan 2; 156(3): 385–91PubMedGoogle Scholar
  19. 19.
    Spore DL, Mor V, Larrat P, et al. Inappropriate drug prescriptions for elderly residents of board and care facilities. Am J Public Health 1997; 87(3): 404–9PubMedCrossRefGoogle Scholar
  20. 20.
    Aparasu RR, Sitzman SJ. Inappropriate prescribing for elderly outpatients. Am J Health Syst Pharm 1999; 56: 433–9PubMedGoogle Scholar
  21. 21.
    Hanlon JT, Schmader KE, Ruby CM, et al. Suboptimal prescribing in older inpatients and outpatients. J Am Geriatr Soc 2001; 49(2): 200–9PubMedCrossRefGoogle Scholar
  22. 22.
    Goulding MR. Inappropriate medication prescribing for elderly ambulatory care patients. Arch Intern Med 2004; 164: 305–12PubMedCrossRefGoogle Scholar
  23. 23.
    Roughead EE, Barratt JD, Gilbert AL. Medication-related problems commonly occurring in an Australian community setting. Pharmacoepidemiol Drug Saf 2004 Feb; 13(2): 83–7PubMedCrossRefGoogle Scholar
  24. 24.
    Rochon PA, Gurwitz JH. Prescribing for seniors: neither too much nor too little. JAMA 1999; 282: 113–5PubMedCrossRefGoogle Scholar
  25. 25.
    Gurwitz JH, Field TS, Judge J, et al. The incidence of adverse drug events in two large academic long-term care facilities. Am J Med 2005; 118: 251–8PubMedCrossRefGoogle Scholar
  26. 26.
    Office of the Inspector General. Prescription drug use in nursing homes. In: Report 2: an inside view by consultant pharmacists. Washington, DC: Department of Health and Human Services, 1997. Report No.: OEI-06-96-00081Google Scholar
  27. 27.
    Zimmerman SI, Girman CJ, Buie VC, et al. The prevalence of osteoporosis in nursing home residents. Osteoporos Int 1999; 9: 151–7PubMedCrossRefGoogle Scholar
  28. 28.
    Smith RL. Calcium and vitamin D supplementation in nursing home residents. J Am Med Dir Assoc 2001; 2: 289–96PubMedCrossRefGoogle Scholar
  29. 29.
    Tamblyn R, Laprise R, Hanley JA, et al. Adverse events associated with prescription drug cost-sharing among poor and elderly persons. JAMA 2001 Jan 24; 285(4): 421–9PubMedCrossRefGoogle Scholar
  30. 30.
    Froom J, Trilling J. Reducing antihypertensive medication use in nursing home patients. Arch Fam Med 2000; 9: 378–83PubMedCrossRefGoogle Scholar
  31. 31.
    Agency for Health Care Policy and Research. Depression in primary care: diagnosis, detection and treatment: treatment of major depression. Clinical Practice Guideline 1993; Vol. 2, No. 5. Rockville (MD): US Department of Human and Health Services, Public Health Service, Agency for Health Care Policy and Research, 1993: 27–9Google Scholar
  32. 32.
    Chapron DJ. Drug disposition and response. In: Delafuente JC, Stewart RB, editors. Therapeutics in the elderly. 3rd ed. Cincinnati (OH): Harvey Whitney Books Company, 2001: 257–88Google Scholar
  33. 33.
    Mangoni AA, Jackson SH. Age-related changes in pharma-cokinetics and pharmacodynamics: basic principles and practical applications. Br J Clin Pharm 2003; 57: 6–14CrossRefGoogle Scholar
  34. 34.
    Stewart RB. Drug use in the elderly. In: Delafuente JC, Stewart RB, editors. Therapeutics in the elderly. 3rd ed. Cincinnati (OH): Harvey Whitney Books Company, 2001: 235–56Google Scholar
  35. 35.
    Tamblyn RM, McLeod PJ, Abrahamowicz M, et al. Questionable prescribing for elderly patients in Quebec. CMAJ 1994; 150: 1801–9PubMedGoogle Scholar
  36. 36.
    Lane CJ, Bronskill SE, Sykora K. Potentially inappropriate prescribing in Ontario community-dwelling older adults and nursing home residents. J Am Geriatr Soc 2004; 52: 861–6PubMedCrossRefGoogle Scholar
  37. 37.
    Bjorkman IK, Fastbom J, Schmidt IK. Drug-drug interactions in the elderly. Ann Pharmacother 2002; 36: 1657–81CrossRefGoogle Scholar
  38. 38.
    van Dijk KN, deVries CS, van den Berg PB, et al. Drug utilisation in dutch nursing homes. Eur J Clin Pharmacol 2000; 55: 765–71PubMedCrossRefGoogle Scholar
  39. 39.
    Giron MS, Wang HX, Bernsten C, et al. The appropriateness of drug use in an older nondemented and demented population. J Am Geriatr Soc 2001; 49: 277–83PubMedCrossRefGoogle Scholar
  40. 40.
    Ruths S, Straand J, Nygaard HA. Multidisciplinary medication review in nursing home residents: what are the most significant drug-related problems? The Bergen District Nursing Home (BEDNURS) study. Qual Saf Health Care 2003; 12: 176–80PubMedCrossRefGoogle Scholar
  41. 41.
    Chou HJ, Huang CM, Tarn YH, et al. Drug regimen review in a nursing home in Taiwan [abstract]. 64th Congress of FIP, World Congress of Pharmacy and Pharmaceutical Sciences; 2004 Sep 4–9; New Orleans (LA), 70Google Scholar
  42. 42.
    McDonald HP, Garg AX, Haynes RB. Interventions to enhance patient adherence to medication prescriptions: scientific review. JAMA 2002; 288: 2868–79PubMedCrossRefGoogle Scholar
  43. 43.
    Classen D. Medication safety: moving from illusion to reality. JAMA 2003; 289: 1154–6PubMedCrossRefGoogle Scholar
  44. 44.
    Peters NL. Snipping the thread of life: antimuscarinic side effects of medications in the elderly. Arch Intern Med 1989; 149: 2414–20PubMedCrossRefGoogle Scholar
  45. 45.
    Mintzer J, Burns A. Anticholinergic side-effects of drugs in elderly people. J R Soc Med 2000; 93: 457–62PubMedGoogle Scholar
  46. 46.
    Tune LE. Anticholinergic effects of medication in elderly patients. J Clin Psychiatry 2001; 62Suppl. 21: 11–4PubMedGoogle Scholar
  47. 47.
    Field TS, Gurwitz JH, Harrold LR, et al. Risk factors for adverse drug events among older adults in the ambulatory setting. J Am Geriatr Soc 2004; 52: 1349–54PubMedCrossRefGoogle Scholar
  48. 48.
    Field TS, Gurwitz JH, Avorn J, et al. Risk factors for adverse drug events among nursing home residents. Arch Intern Med 2001; 161: 1629–34PubMedCrossRefGoogle Scholar

Copyright information

© Adis Data Information BV 2005

Authors and Affiliations

  1. 1.SuffolkUSA
  2. 2.American Society of Consultant Pharmacists FoundationAlexandriaUSA

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