Comparison of prescribing criteria in hospitalised Australian elderly

  • Wararat Pattanaworasate
  • Lynne Emmerton
  • Lisa Pulver
  • Karl Winckel
Keywords: Drug Utilization Review, Aged, Australia


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.


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1. Australian Social Trends. Population projections. Canberra: Australian Bureau of Statistics. Available from . Accessed 28 October 2009.

2. Veterans' MATES. Veteran's medicines advice and therapeutics education services. Therapeutic brief 8-reducing adverse drug events (ADEs) for your veteran patients. Available from . Accessed 28 October 2009.

3. Laroche ML, Charmes JP, Bouthier F, Merle L. Inappropriate medications in the elderly. Clin Pharmacol Ther. 2009;85(1):94-97.

4. Beers MH, Ouslander JG, Rollingher I, Reuben DB, Brooks J, Beck JC. Explicit criteria for determining inappropriate medication use in nursing home residents. Arch Intern Med. 1991;151:1825-1832.

5. Fick DM, Cooper JW, Wade WE, Waller JL, Maclean JR, Beers MH. Updating the Beers criteria for potentially inappropriate medication use in older adults. Arch Intern Med. 2003;163:2716-2724.

6. Beers MH. Explicit criteria for determining potentially inappropriate medication use by the elderly. Arch Intern Med. 1997;157(14):1531-1536.

7. Basger BJ, Chen TF, Moles RJ. Inappropriate medication use and prescribing indicators in elderly Australians. Drugs Aging. 2008;25(9):777-793.

8. Spinewine A, Schmader KE, Barber N, Hughes C, Lapane KL, Swine C, Hanlon JT. Appropriate prescribing in elderly people: how well can it be measured and optimised? Lancet. 2007;370:173-184.

9. Goulding MR. Inappropriate medication prescribing for elderly ambulatory care patients. Arch Intern Med. 2004;164:305-312.

10. Lau DT, Kasper JD, Potter DE, Lyles A, Bennett RG. Hospitalization and death associated with potentially inappropriate medication prescriptions among elderly nursing home residents. Arch Intern Med. 2005;165:68-74.

11. McLeod PJ, Huang AR, Tamblyn RM, Gayton DC. Defining inappropriate practices in prescribing for elderly people: a national consensus panel. Can Med Assoc J. 1997;156(3):385-391.

12. Naugler CT, Brymer C, Stolee P, Arcese ZA. Development and validation of an improving prescribing in the elderly tool. Can J Clin Pharmacol. 2000;7:103-107.

13. Barry PJ, O’Keefe N, O’Connor KA, O’Mahony D. Inappropriate prescribing in the elderly: a comparison of the Beers criteria and the improved prescribing in the elderly tool (IPET) in acutely ill elderly hospitalized patients. J Clin Pharm Therap. 2006;31:617-626.

14. Gallagher P, Ryan C, Byrne S, Kennedy J, O'Mahony D. STOPP (Screening Tool of Older Persons' Prescriptions) and START (Screening Tool to Alert Doctors to Right Treatment): consensus validation. Int J Clin Pharmacol Ther. 2008;46(2):72-83.

15. Rancourt C, Moisan J, Baillargeon L, Verreault R, Laurin D, Gregoire JP. Potentially inappropriate prescriptions for older patients in long-term care. BMC Geriatr. 2004;4:9.

16. Onder G, Landi F, Liperoti R, Fialova D, Gambassi G, Bernabei R. Impact of inappropriate drug use among hospitalized older adults. Eur J Clin Pharmacol. 2005;61:453-459.

17. Fialova D, Topinkova E, Gambassi G, Finne-Soveri H, Jónsson PV, Carpenter I, Schroll M, Onder G, Sorbye LW, Wagner C, Reissigova J, Bernabei R. Potentially inappropriate medication use among elderly home care patients in Europe. JAMA. 2005;293(11):1348-1358.

18. Roughead EE, Anderson B, Gilbert AL. Potentially inappropriate prescribing among Australian veterans and war widows/widowers. Intern Med J. 2007;37:402-405.

19. National Prescribing Service. Indicators of quality prescribing in Australian general practice: a manual for users. Sydney: National Prescribing Service Limited; 2006.

20. Elliott RA, Woodward MC, Oborne CA. Indicators of prescribing quality for elderly hospital inpatients. Aust J Hosp Pharm. 2001;31(1):19-25.

21. Elliott RA, Woodward MC, Oborne CA. Quality of prescribing for elderly inpatients at nine hospitals in Victoria, Australia. J Pharm Pract Res. 2003;33(2):101-105.

22. The Royal Australian College of General Practitioners, the Australasian Society of Clinical and Experimental Pharmacologists and Toxicologists, and the Pharmaceutical Society of Australia. Australian Medicines Handbook. Adelaide: Australian Medicines Handbook; 2007.

23. Caterino JM, Emond JA, Camargo CA Jr. Inappropriate medication admission to the acutely ill elderly: a nationwide emergency department study. J Am Geriatr Soc. 2004;52(11):1847-1855.

24. Beers MH, Ouslander JG, Fingold SF, Morgenstern H, Reuben DB, Rogers W, Zeffren MJ, Beck JC. Inappropriate medication prescribing in skilled-nursing facilities. Ann Intern Med. 1992;117:684-689.

25. Zhan C, Sangl J, Bierman AS, Miller MR, Friedman B, Wickizer SW, Meyer GS. Potentially inappropriate medication use in the community-dwelling elderly: findings from the 1996 medical expenditure panel survey. JAMA. 2001;286(22):2823-2829.
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