Trends in the prescription of inappropriate drugs for the elderly between 1995 and 1999

Background: Using criteria developed by Beers et al between 1991 and 1997, previous studies have reported high levels of inappropriate drug prescribing for community-dwelling elderly patients (age ≥65 years). However, it is not known whether the Beers criteria have had a beneficial effect on prescribing practices. Objectives: The aims of this study were to compare the prevalence of potentially inappropriate drug use (based on the Beers list) among older Americans between 1995 and 1999; to determine whether any decreases in such use were more likely to be the result of improved adherence to guidelines or of replacement of older medications by newer drugs; and to examine individual characteristics that place elderly patients at increased risk for inappropriate drug use. Methods: This was a panel study involving nationally representative samples of community-dwelling elderly persons from the 1995 and 1999 Medicare Current Beneficiary Surveys (MCBS). For comparison, data were analyzed from samples of disabled Medicare beneficiaries aged <65 years for the same periods. The samples were assessed for the use of 36 individual drugs, drug classes, and combinations carrying a risk for adverse outcomes in the elderly based on the 1997 Beers criteria for drugs to be avoided in this population. Results: The study samples contained 7628 community-dwelling elderly persons from the 1995 MCBS and 8902 from the 1999 MCBS, and 1863 and 1851 disabled Medicare beneficiaries aged <65 years for the respective survey years. The proportion of elderly patients taking ≥1 drug on the Beers list declined from 24.8% in 1995 to 21.3% in 1999 (P < 0.05). There was a nonsignificant increase in the proportion of disabled Medicare beneficiaries taking ≥1 drug on the Beers list from 31.1% in 1995 to 31.5% in 1999. Conclusions: There was a significant decline in the use of potentially inappropriate drugs by elderly patients between 1995 and 1999, particularly in the use of those drugs linked to the most severe outcomes. However, ∼7 million elderly patients still received potentially inappropriate drugs in 1999, underscoring the continued need for effective interventions to improve prescribing for this vulnerable population.