Inappropriate drug prescription in older people

Drugs are widely used to treat acute and chronic conditions in older people. However, the incidence of adverse drug reactions increases with age and are a frequent cause of hospital admission, especially in patients with multimorbidity and polypharmacy. Many of these adverse drug reactions could potentially be prevented. A prescription is considered to be potentially inappropriate in an older person if it carries a significant risk of producing an adverse drug reaction, especially when a safer alternative is available. In recent years, many instruments have been developed to help detecting potentially inappropriate prescriptions, most of them explicit lists of drugs that should not be used or cannot be used in the presence of certain conditions. The most widely used are the Beers-AGS criteria and the STOPP-START criteria. A systematic use of such instruments has been shown to improve not only the quality of prescriptions, but also several health outcomes in older multimorbid patients. Research is growing on the new concept of deprescription, described as the process of withdrawing inappropriate drugs, supervised by a health care professional, with the intention of reducing polypharmacy, improving outcomes and limiting iatrogenia. Prescriptors should become familiar with the different tools available to improve prescription quality and reduce drug related risks in older complex patients.