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Potentially inappropriate prescribing and adverse drug reactions in the elderly: a population-based study

Journal article
Authors K. Hedna
Katja M Hakkarainen
Hanna Gyllensten
A. K. Jonsson
Max Petzold
S. Hagg
Published in European Journal of Clinical Pharmacology
Volume 71
Issue 12
Pages 1525-1533
ISSN 0031-6970
Publication year 2015
Published at Institute of Medicine, Department of Public Health and Community Medicine, Health Metrics
Pages 1525-1533
Language en
Keywords Inappropriate prescribing, Elderly, Adverse drug reactions, Retrospective study, Medical records, STOPP SCREENING TOOL, OLDER-PEOPLE, STOPP/START CRITERIA, MEDICATION, ERRORS, PRIMARY-CARE, PREVALENCE, EVENTS, RISK, PRESCRIPTIONS, DATABASE
Subject categories Clinical pharmacology


Potentially inappropriate prescriptions (PIPs) criteria are widely used for evaluating the quality of prescribing in elderly. However, there is limited evidence on their association with adverse drug reactions (ADRs) across healthcare settings. The study aimed to determine the prevalence of PIPs, defined by the Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria, in the Swedish elderly general population and to investigate the association between PIPs and occurrence of ADRs. Persons a parts per thousand yen65 years old were identified from a random sample of 5025 adults drawn from the Swedish Total Population Register. A retrospective cohort study was conducted among 813 elderly with healthcare encounters in primary and specialised healthcare settings during a 3-month period in 2008. PIPs were identified from the Swedish Prescribed Drug Register, medical records and health administrative data. ADRs were independently identified by expert reviewers in a stepwise manner using the Howard criteria. Multivariable logistic regression examined the association between PIPs and ADRs. Overall, 374 (46.0 %) persons had a parts per thousand yen1 PIPs and 159 (19.5 %) experienced a parts per thousand yen1 ADRs during the study period. In total, 29.8 % of all ADRs was considered caused by PIPs. Persons prescribed with PIPs had more than twofold increased odds of experiencing ADRs (OR 2.47; 95 % CI 1.65-3.69). PIPs were considered the cause of 60 % of ADRs affecting the vascular system, 50 % of ADRs affecting the nervous system and 62.5 % of ADRs resulting in falls. PIPs are common among the Swedish elderly and are associated with increased odds of experiencing ADRs. Thus, interventions to decrease PIPs may contribute to preventing ADRs, in particular ADRs associated with nervous and vascular disorders and falls.

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