Studies of Prescribing Outcomes

Ray et al. identified 1021 patients with hip fractures and matched case-controls. They concluded that the risk of hip fracture was approximately doubled for patients taking CNS agents with half-lives over 24 h (odds ratio (OR) = 1.8). For tricyclic antidepressants, OR = 1.9; for antipsychotics, OR = 2.0. The risk was dose related. "These data [show] that the sedative ... effects of psychotropic drugs increase the risk of falling and fractures in elderly persons."51 (See Chapter 2.)

Lindley et al. studied 416 successive admissions of elderly patients to a teaching hospital. Of the 416, 26 (6.3%) were attributed to adverse drug reactions (ADRs). Thirteen of these 26 (50%) were due to inappropriate prescribing. Forty-eight patients (11.5%) had a total of 51 drugs with absolute contraindications (CIs) (3.8% of prescriptions). At admission, 175 unnecessary drugs were discontinued in 113 (27%) patients. A total of 103 patients (27.0% of those on medication) experienced 151 ADRs. Seventy-five of the 151 ADRs (49.7%) were due to unnecessary drugs or drugs with absolute CIs. This ADR rate was significantly higher than that observed for all prescriptions. The authors concluded, " ... much drug-related morbidity in the elderly population may be avoidable, as it is due to inappropriate prescribing."52

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