Differences in drug prescribing patterns in elderly parkinsonian patients identified at hospital admission.

In the period July 1984 to June 1993 a total of 4541 admissions to a Department of Medicine for the Elderly were investigated. Approximately 9% of the total were diagnosed to have parkinsonism. Full drug histories together with the available demographic and clinical data were investigated in order to identify differences in the prescribing patterns in this group compared to those of non-parkinsonian patients admitted during this time frame. There was a statistically significant lower incidence among the parkinsonian group for the prescribing of all cardiovascular drug groups, anticoagulants, hypoglycaemics, bronchodilators, and corticosteroids compared with non-parkinsonian patients. In contrast, the incidence of hypnotics, laxatives, antidepressants and antipsychotics were significantly higher.

Changes in prescribing patterns of oral hypoglycaemics in elderly patients, over a period of 10 years: matching with general practitioners' perceptions of their own prescribing.

A 10-year hospital admissions database had demonstrated a steep decline in the prescribing of chlorpropamide, and to a lesser degree, of glibenclamide, with tolbutamide, metformin and the most recently introduced oral hypoglycaemic, gliclazide, maintaining relatively uniform levels. Glipizide was the most popular emerging agent. Interviews with 20 general practitioners (GPs) revealed that 55% had a definite first choice agent with a priority order of gliclazide, tolbutamide and glibenclamide. For the remaining GPs without a sole preference, gliclazide (30%), glipizide (30%) and glibenclamide (20%) featured as their most commonly prescribed agents.

Development and use of a gastropathy index for ranking the safety of non-steroidal anti-inflammatory drugs in the elderly.

This study, conducted at the Royal Devon & Exeter Hospital, Department of Geriatric Medicine, was carried out using 2987 sets of admission data. The number of patients taking non-steroidal anti-inflammatory drugs was identified together with a suite of clinical factors used to indicate the presence of gastrointestinal pathology. From this a gastropathy index was developed to establish a rank order for the individual drugs. Ketoprofen, piroxicam and fenbufen were all significantly associated with factors suggestive of gastropathy, whereas indomethacin, diclofenac and ibuprofen appeared relatively free of such association. Naproxen, azapropazone and mefenamic acid ranked in an intermediate category. This noninvasive analysis of routinely acquired data provides a potentially useful discriminator between individual non-steroidal anti-inflammatory drugs for this age group.

An investigation of the association of benzodiazepines and other hypnotics with the incidence of falls in the elderly.

Clinical and medication data from 2,878 admissions to a Department for Care of the Elderly were examined retrospectively to determine the association between the administration of hypnotics/benzodiazepines and the incidence of falls. Only lorazepam prescribed to females and nitrazepam prescribed to males were associated with a significantly increased incidence of falls. Women fell significantly more frequently than men, and 7.5% of falls resulted in fractures. Stroke was the most common major diagnosis in fall-cases, followed by infection, Parkinsonism and confusion.

The construction of biochemical reference ranges and the identification of possible adverse drug reactions in the elderly.

In the assessment of adverse drug reactions (ADRs) it is important to establish what is a normal range of values for a given biochemical measurement. Furthermore, such ranges need to be specific to the study population, for example, the elderly. A mixture of Gaussian distributions has been used in the construction of the reference ranges with maximum likelihood used to obtain estimates of the unknown parameters. With this approach, well-defined reference ranges have been established. Brief details are given of the numbers of ADRs identified in the study population using these ranges.

The design of an algorithm for pharmacists to evaluate ADRs in the elderly.

An algorithm has been developed to help pharmacists who monitor patients being admitted to hospital to evaluate identified adverse drug reactions (ADRs). The design features six operational axes, comprising four subdivisions, with a unique score assigned to each. The final total of the sum of the individual scores for the six axes provides a measure of the probability that a suspicious event is drug-related.