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Am J Geriatr Pharmacother. 2003 Sep;1(1):38-43.

Update on drug-related problems in the elderly.

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Institute for the Study of Geriatric Pharmacotherapy, Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN 55455, USA.



Although pharmacotherapy for the elderly can treat diseases and improve well-being, its benefits can be compromised by drug-related problems.


This article reviews recent publications concerning drug-related problems in the elderly, as well as articles describing the development of 3 sets of quality indicators for medication use in the elderly.


Relevant articles were identified through a search of MEDLINE (2002-March 2003) for articles on drug-related problems, inappropriate prescribing, and adverse drug events in the elderly.


The review included 7 articles published in 2002 and 2003. A study in ambulatory elderly persons reported that approximately 5.0% of patients had > or =1 adverse drug event within the previous year. Another study found that approximately 20.0% of ambulatory elderly persons used > or =1 inappropriate drug, as defined by drug utilization review (DUR) criteria, with drug-disease interactions and duration of use being the most common drug-related problems. A third study involving elderly individuals in assisted living facilities found that 16.0% used > or =1 inappropriate drug, as defined by the Beers criteria. Another study examined whether inappropriate drug use, as defined by the Beers or DUR criteria, was associated with death or a decline in functional status; it found that only use of drugs defined as inappropriate by DUR criteria (particularly those drugs associated with drug-drug or drug-disease interactions) was associated with a decline in the ability to perform basic self-care. Three studies, 1 from the United States, 1 from the United Kingdom, and 1 from Canada, described consensus development of quality indicators for drug use in the elderly, including drugs to avoid, maximum daily dose, drug duplication, limits on duration of use, drug-drug and drug-disease interactions, need for drug monitoring, underuse of necessary drugs to treat or prevent common problems, and inappropriate drug-administration technique.


Drug-related problems are common in elderly patients. Data from recently published studies provide guidance to practitioners and directions for future research.

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