When Medicine Hurts Instead of Helps: Preventing Medication Problems in Older Persons

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A special report by the Alliance for Aging Research made possible by a grant from the American Society of Consultant Pharmacists Foundation.

Executive Summary

Read the Executive Summary, and the eight recommendations made by the Expert Panel.

The Silent Epidemic

Read the Silent Epidemic.

Expert Panel

Richard W. Besdine, M.D. (Chairman)
Professor of Medicine
Director, University of Connecticut Center on Aging
University of Connecticut Health Center

Mark H. Beers, M.D.
Senior Director of Geriatrics & Editor, The Merck Manuals
Merck & Co., Inc.

J. Lyle Bootman, Ph.D.
Dean & Professor, College of Pharmacy
Executive Director, Health Outcomes and Pharmaco Economics Research (HOPE) Center
University of Arizona

Terry T. Fulmer, R.N., Ph.D., F.A.A.N.
Professor & Director
Center of Nursing Research
New York University

Philip Gerbino, Pharm.D.
President
Philadelphia College of Pharmacy & Science

Henri R. Manasse, Jr., Ph.D.
Executive Vice President
American Society of Health-System Pharmacists

May L. Wykle, Ph.D., R.N, F.A.A.N
FPB School of Nursing
Florence Cellar Professor & Director of the University Center on Aging & Health
Case Western Reserve University

References

Alliance for Aging Research (1996) Will You Still Treat Me When I’m 65?: The National Shortage of Geriatricians, Washington, DC.

Agency for Health Care Policy and Research (1991) National Medical Expenditure Survey. U.S. Department of Health and Human Services, Washington, DC.

Avorn J (1995—Spring) Medication Use and the Elderly: Current Status and Opportunities. Health Affairs, 278—86.

Bates DW, Spell N, Cullen DJ et al. (1997) The Costs of Adverse Drug Events in Hospitalized Patients. Journal of the American Medical Association, 277: 307—11.

Beers MH, Ouslander JG, Rollingher I, Reuben DB, Brooks J, Beck JC (1991) Explicit Criteria for Determining Inappropriate Medication Use in Nursing Home Residents. Archives of Internal Medicine, 151: 1825—32.

Beers MH (1997) Explicit Criteria for Determining Potentially Inappropriate Medication Use in the Elderly. Archives of Internal Medicine, 157: 1531—6.

Bootman JL, Harrison DL, Cox E (1997) The Health Care Cost of Drug—Related Morbidity and Mortality in Nursing Facilities. Archives of Internal Medicine, 157: 2089—96.

Chutka DS, Evan JM, Fleming KC, Mikkelson KG (1995) Drug Prescribing For Elderly Patients. Mayo Clinic Proceedings, 70: 685—93.

Classen DC, Pestonik SL, Evans RS, Lloyd JF, Burke JP (1997) Adverse Drug Events in Hospitalized Patients. Journal of the American Medical Association, 227:301—6.

General Accounting Office (1996) Prescription Drugs and the Elderly: Many Still Receive Potentially Harmful Drugs Despite Recent Improvements, Washington, DC.

Gurwitz J, Monane M, Monane S, Avorn J Polypharmacy. (1997) In: Morris JN, Lipsitz LA, Murphy K, Bellville-Taylor P, eds. Quality Care in the Nursing Home. St. Louis, MO: Mosby—Year Book, 13—25.

Hepler CD, Strand LM (1990) Opportunities and Responsibilities in Pharmaceutical Care. American Journal of Hospital Pharmacy, 47:533—43.

Johnson JA, Bootman JL (1995) Drug-Related Morbidity And Mortality: A Cost-of-Illness Model. Archives of Internal Medicine, 155: 1949—56.

Lazarou J, Pomeranz BH, Corey PN (1998) Incidence of Adverse Drug Reactions in Hospitalized Patients: A Meta-Analysis Of Prospective Studies. Journal of the American Medical Association, 279: 1200—5.

Manasse HR Jr. (1989) Medication Use in an Imperfect World: Drug Misadventuring as an Issue of Public Policy, Part 1. American Journal of Hospital Pharmacy, 46:929—44.

Manasse HR Jr. (1989) Medication Use in an Imperfect World: Drug Misadventuring as an Issue of Public Policy, Part 2. American Journal of Hospital Pharmacy, 46:1141—52.

Montamat SC, Cusack FJ, Vestal RE (1989) Management of Drug Therapy in the Elderly. New England Journal of Medicine, 321: 303—9.

Nananda C, Fanale JE, Kronholm P (1990) The Role of Medication Noncompliance and Adverse Drug Reactions in Hospitalizations of the Elderly, Archives of Internal Medicine. 150 (4): 841—46.

National Center for Health Statistics (1995) Current Estimates From the National Health Interview Survey, 1994. Vital Health Statistics, 10(193): 81—2.

Office of Inspector General (1997) Prescription Drug Use in Nursing Homes: Report 3 — A Pharmaceutical Review and Inspections Recommendations, Department of Health and Human Services, Washington, DC.

Ray WA, Griffin MR, Avorn J (1993) Evaluating Drugs After Their Approval for Clinical Use [Sounding Board]. New England Journal of Medicine, 329: 2029—32.

Sloan RW (1992) Principles of Drug Therapy in Geriatric Patients. American Family Physician, 45: 2709—18.

Additional Copies

For additional copies, contact: Alliance for Aging Research 2021 K Street, NW, Suite 305 Washington, DC 20006 Phone (202) 293-2856 Fax (202) 785-8574 www.agingresearch.org


The Alliance for Aging Research gratefully acknowledges our expert panel members for their contributions in developing this report. We greatly appreciate the support of the American Society of Consultant Pharmacists Research and Education Foundation.

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