Open Access Research article

Potentially inappropriate prescribing among older people in the United Kingdom

Marie C Bradley5*, Nicola Motterlini2, Shivani Padmanabhan4, Caitriona Cahir3, Tim Williams4, Tom Fahey2 and Carmel M Hughes1

Author Affiliations

1 Clinical and Translational Epidemiology Branch, National Cancer Institute, Rockville, MD, USA

2 HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Beaux Lane House, Mercer Street, Dublin, Ireland

3 Department of Pharmacology and Therapeutics, Trinity College Dublin, Dublin, Ireland

4 Clinical Practice Research Datalink, Medicines and Healthcare Products Regulatory Agency, London, UK

5 Clinical and Translational Epidemiology Branch, Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, 4E320, 20850 Rockville, MD, USA

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BMC Geriatrics 2014, 14:72  doi:10.1186/1471-2318-14-72

Published: 12 June 2014

Abstract

Background

Potentially inappropriate prescribing (PIP) in older people is associated with increases in morbidity, hospitalisation and mortality. The objective of this study was to estimate the prevalence of and factors associated with PIP, among those aged ≥70 years, in the United Kingdom, using a comprehensive set of prescribing indicators and comparing these to estimates obtained from a truncated set of the same indicators.

Methods

A retrospective cross-sectional study was carried out in the UK Clinical Practice Research Datalink (CPRD), in 2007. Participants included those aged ≥ 70 years, in CPRD. Fifty-two PIP indicators from the Screening Tool of Older Persons Potentially Inappropriate Prescriptions (STOPP) criteria were applied to data on prescribed drugs and clinical diagnoses. Overall prevalence of PIP and prevalence according to individual STOPP criteria were estimated. The relationship between PIP and polypharmacy (≥4 medications), comorbidity, age, and gender was examined. A truncated, subset of 28 STOPP criteria that were used in two previous studies, were further applied to the data to facilitate comparison.

Results

Using 52 indicators, the overall prevalence of PIP in the study population (n = 1,019,491) was 29%. The most common examples of PIP were therapeutic duplication (11.9%), followed by use of aspirin with no indication (11.3%) and inappropriate use of proton pump inhibitors (PPIs) (3.7%). PIP was strongly associated with polypharmacy (Odds Ratio 18.2, 95% Confidence Intervals, 18.0-18.4, P < 0.05). PIP was more common in those aged 70–74 years vs. 85 years or more and in males. Application of the smaller subset of the STOPP criteria resulted in a lower PIP prevalence at 14.9% (95% CIs 14.8-14.9%) (n = 151,598). The most common PIP issues identified with this subset were use of PPIs at maximum dose for > 8 weeks, NSAIDs for > 3 months, and use of long-term neuroleptics.

Conclusions

PIP was prevalent in the UK and increased with polypharmacy. Application of the comprehensive set of STOPP criteria allowed more accurate estimation of PIP compared to the subset of criteria used in previous studies. These findings may provide a focus for targeted interventions to reduce PIP.

Keywords:
Potentially inappropriate prescribing; Older people; Screening tool of older persons potentially inappropriate Prescriptions (STOPP); CPRD