The Beers
criteria (2003) and McLeod criteria (1997) have been applied internationally
to quantify inappropriate prescribing in elderly populations.
Similarly, guidelines have been published locally by the National
Prescribing Service (NPS).
Objective: This study aimed to adapt, evaluate and compare the
utility of these three established criteria in measuring prescribing
appropriateness in a sample of hospitalised elderly patients.
Methods: Initial refinement of the criteria produced versions
applicable to Australian practice. Inpatient records of 202 patients
aged 65 years or older in six wards of the Princess Alexandra
Hospital, Brisbane, Australia, were reviewed using the adapted
criteria. ‘Potentially inappropriate’ prescribing was descriptively
analysed using relevant denominators.
Results: The adapted criteria collectively listed 70 ‘potentially
inappropriate’ medicines or drug groups and 116 ‘potentially inappropriate’
prescribing practices. Patients (mean age 80.0; SD=8.3 years)
were prescribed, a median of eight medicines (SD=4.0). At least
one ‘potentially inappropriate’ medicine was identified in 110
(55%) patients. ‘Potentially inappropriate’ prescribing practices
averaged 1.1 per patient (range 1-6). The adapted Beers criteria
identified more ‘potentially inappropriate’ medicines/practices
(44%, 101/232) than the McLeod criteria (41%) and NPS criteria
(16%). Aspirin, benzodiazepines, beta-blockers and dipyridamole
were most commonly identified.
Conclusion: The Beers and McLeod criteria, developed internationally,
required considerable modification for local prescribing. The
three criteria differed in their focus and approaches, such that
development and validation of national criteria, using the key
features of these models, is recommended. There is potential to
apply validated guidelines in clinical practice and review of
prescribing, but only to supplement clinical judgement.
