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Canadian Family Physician logoLink to Canadian Family Physician
. 2001 Jun;47:1198–1204.

What drugs are our frail elderly patients taking? Do drugs they take or fail to take put them at increased risk of interactions and inappropriate medication use?

C Frank 1, M Godwin 1, S Verma 1, A Kelly 1, A Birenbaum 1, R Seguin 1, J Anderson 1
PMCID: PMC2018514  PMID: 11421047

Abstract

OBJECTIVE: To determine whether there were discrepancies between what medications frail elderly outpatients took and what physicians thought they took and whether discrepancies put patients at risk of taking inappropriate drugs and of increasing the potential for drug interactions. DESIGN: Case series. SETTING: Day Hospital Program at St Mary's of the Lake Hospital in Kingston, Ont. PARTICIPANTS: One hundred twenty community-living elderly patients attending the Day Hospital Program in 1998. Three patients and two family physicians declined to participate. MAIN OUTCOME MEASURES: Lists of medications being taken by patients compared with lists of medications in physicians' charts. Category according to explicit criteria that each drug fell into and risk of drug interactions as determined by the Clinidata Drug Interaction Program. RESULTS: Of the 120 patients, 115 had at least one discrepancy between their lists of medications and their physicians' lists. Of the 1390 medications on the lists, 521 (37%) were being taken by patients without their doctors' knowledge, 82 (6%) were not being taken by patients when doctors thought they were, and 133 (10%) were on both patients' and their doctors' lists but with dosages or frequency of administration that were different. More potential drug interactions were identified on patients' lists than on physicians' lists. No increase in risk of inappropriate drug use was identified. CONCLUSION: Family physicians are often unaware of all the medications their patients are actually taking. Medications used by patients without physicians' knowledge increase the likelihood of drug interactions. Family physicians should look at and inquire about all medications, including over-the-counter drugs, their patients are actually taking.

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Selected References

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  1. Abernathy T. J., Lentjes D. M. A three-year census of dependent elderly. Can J Public Health. 1990 Jan-Feb;81(1):22–26. [PubMed] [Google Scholar]
  2. Baum C., Kennedy D. L., Forbes M. B., Jones J. K. Drug use in the United States in 1981. JAMA. 1984 Mar 9;251(10):1293–1297. [PubMed] [Google Scholar]
  3. Beers M. H. Explicit criteria for determining potentially inappropriate medication use by the elderly. An update. Arch Intern Med. 1997 Jul 28;157(14):1531–1536. [PubMed] [Google Scholar]
  4. Beers M. H., Munekata M., Storrie M. The accuracy of medication histories in the hospital medical records of elderly persons. J Am Geriatr Soc. 1990 Nov;38(11):1183–1187. doi: 10.1111/j.1532-5415.1990.tb01496.x. [DOI] [PubMed] [Google Scholar]
  5. Beers M. H., Ouslander J. G., Fingold S. F., Morgenstern H., Reuben D. B., Rogers W., Zeffren M. J., Beck J. C. Inappropriate medication prescribing in skilled-nursing facilities. Ann Intern Med. 1992 Oct 15;117(8):684–689. doi: 10.7326/0003-4819-117-8-684. [DOI] [PubMed] [Google Scholar]
  6. Beers M. H., Ouslander J. G., Rollingher I., Reuben D. B., Brooks J., Beck J. C. Explicit criteria for determining inappropriate medication use in nursing home residents. UCLA Division of Geriatric Medicine. Arch Intern Med. 1991 Sep;151(9):1825–1832. [PubMed] [Google Scholar]
  7. Butler R. N. National Brown Bag Day. Annual reviews of older patients' medications would reduce the risk of reactions. Geriatrics. 1996 Dec;51(12):9–10. [PubMed] [Google Scholar]
  8. Claoué C., Elkington A. R. Informing the hospital of patients' drug regimens. Br Med J (Clin Res Ed) 1986 Jan 11;292(6513):101–101. doi: 10.1136/bmj.292.6513.101. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Fugh-Berman A. Herb-drug interactions. Lancet. 2000 Jan 8;355(9198):134–138. doi: 10.1016/S0140-6736(99)06457-0. [DOI] [PubMed] [Google Scholar]
  10. Hanlon J. T., Schmader K. E., Koronkowski M. J., Weinberger M., Landsman P. B., Samsa G. P., Lewis I. K. Adverse drug events in high risk older outpatients. J Am Geriatr Soc. 1997 Aug;45(8):945–948. doi: 10.1111/j.1532-5415.1997.tb02964.x. [DOI] [PubMed] [Google Scholar]
  11. Honig P. K., Gillespie B. K. Drug interactions between prescribed and over-the-counter medication. Drug Saf. 1995 Nov;13(5):296–303. doi: 10.2165/00002018-199513050-00003. [DOI] [PubMed] [Google Scholar]
  12. Hylek E. M., Heiman H., Skates S. J., Sheehan M. A., Singer D. E. Acetaminophen and other risk factors for excessive warfarin anticoagulation. JAMA. 1998 Mar 4;279(9):657–662. doi: 10.1001/jama.279.9.657. [DOI] [PubMed] [Google Scholar]
  13. Jones J. K. Assessing potential risk of drugs: the elusive target. Ann Intern Med. 1992 Oct 15;117(8):691–692. doi: 10.7326/0003-4819-117-8-691. [DOI] [PubMed] [Google Scholar]
  14. Lamy P. P. Adverse drug effects. Clin Geriatr Med. 1990 May;6(2):293–307. [PubMed] [Google Scholar]
  15. Lindley C. M., Tully M. P., Paramsothy V., Tallis R. C. Inappropriate medication is a major cause of adverse drug reactions in elderly patients. Age Ageing. 1992 Jul;21(4):294–300. doi: 10.1093/ageing/21.4.294. [DOI] [PubMed] [Google Scholar]
  16. McLeod P. J., Huang A. R., Tamblyn R. M., Gayton D. C. Defining inappropriate practices in prescribing for elderly people: a national consensus panel. CMAJ. 1997 Feb 1;156(3):385–391. [PMC free article] [PubMed] [Google Scholar]
  17. Nathan A., Goodyer L., Lovejoy A., Rashid A. 'Brown bag' medication reviews as a means of optimizing patients' use of medication and of identifying potential clinical problems. Fam Pract. 1999 Jun;16(3):278–282. doi: 10.1093/fampra/16.3.278. [DOI] [PubMed] [Google Scholar]
  18. Nolan L., O'Malley K. Prescribing for the elderly. Part I: Sensitivity of the elderly to adverse drug reactions. J Am Geriatr Soc. 1988 Feb;36(2):142–149. doi: 10.1111/j.1532-5415.1988.tb01785.x. [DOI] [PubMed] [Google Scholar]
  19. Price D., Cooke J., Singleton S., Feely M. Doctors' unawareness of the drugs their patients are taking: a major cause of overprescribing? Br Med J (Clin Res Ed) 1986 Jan 11;292(6513):99–100. doi: 10.1136/bmj.292.6513.99. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Quinn K., Baker M. J., Evans B. A population-wide profile of prescription drug use in Saskatchewan, 1989. CMAJ. 1992 Jun 15;146(12):2177–2186. [PMC free article] [PubMed] [Google Scholar]
  21. Schneider J. K., Mion L. C., Frengley J. D. Adverse drug reactions in an elderly outpatient population. Am J Hosp Pharm. 1992 Jan;49(1):90–96. [PubMed] [Google Scholar]
  22. Stuck A. E., Beers M. H., Steiner A., Aronow H. U., Rubenstein L. Z., Beck J. C. Inappropriate medication use in community-residing older persons. Arch Intern Med. 1994 Oct 10;154(19):2195–2200. [PubMed] [Google Scholar]
  23. Tamblyn R. M., McLeod P. J., Abrahamowicz M., Laprise R. Do too many cooks spoil the broth? Multiple physician involvement in medical management of elderly patients and potentially inappropriate drug combinations. CMAJ. 1996 Apr 15;154(8):1177–1184. [PMC free article] [PubMed] [Google Scholar]
  24. Tamblyn R. M., McLeod P. J., Abrahamowicz M., Monette J., Gayton D. C., Berkson L., Dauphinee W. D., Grad R. M., Huang A. R., Isaac L. M. Questionable prescribing for elderly patients in Quebec. CMAJ. 1994 Jun 1;150(11):1801–1809. [PMC free article] [PubMed] [Google Scholar]
  25. Torrible S. J., Hogan D. B. Medication use and rural seniors. Who really knows what they are taking? Can Fam Physician. 1997 May;43:893–898. [PMC free article] [PubMed] [Google Scholar]
  26. Willcox S. M., Himmelstein D. U., Woolhandler S. Inappropriate drug prescribing for the community-dwelling elderly. JAMA. 1994 Jul 27;272(4):292–296. [PubMed] [Google Scholar]

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