Medicinal prescriptions in geriatrics: Overuse, misuse, underuse. Qualitative analysis from the prescriptions of 200 patients admitted in an acute care geriatric unit

Purpose. - In the elderly three modalities of suboptimal drug prescriptions are known: overuse, misuse, underuse. Patients and methods. - This prospective observational study was conducted between September 2008 and March 2009. The prescriptions of 200 patients aged over 75 years admitted in the acute care geriatric unit at the teaching hospital of Brest (France) have been qualitatively analyzed to assess the prevalence of the three types of suboptimal prescription. Results. - A strong prevalence of overuse (77% of the patients), underuse (64.5%) and at minor degree of misuse (47.5%) were evidenced. Overuse and misuse were more frequent in polypathogical and polyme-dicated patients living in nursing home. Underuse was more prevalent in polypathological patients living at home. No significant relation was found between suboptimal prescriptions, age, gender or cognitive status. Conclusion. - This study demonstrates the strong prevalence of overuse, misuse and underuse prescriptions in hospitalized elderly patient and analyses the most frequently implicated drugs and the different factors predisposing to these suboptimal prescriptions. This way of analysis of prescriptions could be a pertinent method to improve drug prescription in the elderly. (C) 2011 Societe nationale francaise de medecine interne (SNFMI). Publie par Elsevier Masson SAS. Tous droits reserves.