Drug prescribing patterns in elderly patients in a tertiary level hospital

Nachiket Bhaveshaikh, Sangita Sukumaran, Upal Vyas


Background: Elderly people have multiple co morbidities and are often prescribed potentially inappropriate medications (PIMs). As there is paucity of information about the prescribing practices in elderly this study was undertaken to assess drug utilization patterns in elderly patients.

Methods: A prospective observational study was conducted in a tertiary care hospital. A total of 576 prescriptions of elderly patients were included in the study. Prescribing patterns among elderly patients attending OPD and admitted to wards of departments of Medicine, Psychiatry, Dermatology, Pulmonary Medicine, General Surgery, E.N.T., Ophthalmology, Orthopaedics, Obstetrics and Gynaecology were analysed using the prescribing indicators (WHO criteria). The PIMs were identified as per the Beers 2012 criteria.

Results: The average number of drugs per patient was 3.91±1.93 for O.P.D and 7.37 ±2.22 for I.P.D. patients. 37.76% patients in I.P.D. and 26.87% patients in O.P.D. received a medication which was potentially inappropriate as per Beers 2012 criteria. 7.58% (234/3088) of total medications prescribed to patients in the study were potentially inappropriate. There was a significant increase in the number of PIMs (p value ˂0.05) as the total number of drugs prescribed increased.

Conclusions: Educational programmes are needed to reinforce rational prescribing by physicians and precautions should be taken while prescribing potentially inappropriate drugs to elderly patients.


Beers, Elderly, PIMs, Polypharmacy

Full Text:



Momin TG, Pandya RN, Rana DA, Patel VJ. Use of potentially inappropriate medications in hospitalized elderly at a teaching hospital: a comparison between Beers 2003 and 2012 criteria. Indian J Clinic Pharmacol. 2013;45(6):603-7.

National health profile. Report of the Technical Group on Population Projections. National Commission on Population/MOHFW/GOI. 2010. Available from:

Jackson S, Jansen P, Mangoni A. Prescribing for elderly patients. Clinical Pharmacology of Ageing. 1st edition. John Wiley and Sons, Wiley-Blackwell; 2009:1-12.

Amann U, Schmedt N, Garbe E. Prescribing of potentially inappropriate medications for the elderly: an analysis based on the PRISCUS list. Dtsch Arztebl Int. 2012;109(5):69-75.

Fillit HM, Rockwood K, Woodhouse K. Broklehurst’s textbook of geriatric medicine and gerontology. Saunders Elsevier. 7th edition. 2010.

Kutsal Y. Polypharmacy in elderly. Turk Geriatri Dergisi. 2006;9:37-44.

Katzung BG, Masters SB, Trevor AJ. Basic and clinical pharmacology. 11th ed. Tata Mcgrow hill 2009.1037-46.

Arslan S, Atalay A, Kutsal YG. Drug use in elderly. Turk Geriatri Dergisi. 2000; 3(2):56-60.

Hajjar ER, Cafiero AC, Hanlon JT. Polypharmacy in elderly patients. Am J Geriatr Pharmacoth. 2000;5(4):345-51.

Campanelli CM. American geriatrics society updated beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2012;60(4):616-31.

Mahony DO, Gallagher P, Ryan C, Byrne S, Hamilton H, Barry P, Connor MO, Kennedy J. STOPP and START criteria: a new approach to detecting potentially inappropriate prescribing in old age. Europ Geriat Medic. 2010;1:45-51.

Askari M, Wierenga PC, Eslami S, Medlock S, deRooij SE, Abu-Hanna A. Assessing quality of care of elderly patients using the ACOVE quality indicator set: a systematic review. Plos one. 2011;6:1-7.

Tangiisuran B, Wright JE, Van der Cammen TJM, Rajkumar C. Adverse drug reactions in the elderly: challenges in identification and improving preventative strategies. Age Ageing. 2009;38:358-9.

Bakken MS, Ranhoff AH, Engeland A, Ruths S. Inappropriate prescribing for older people admitted to an intermediate-care nursing home unit and hospital wards. Scand J Prim Health Care. 2012;30:169-75.

Shankar PR, Upadhyay DK, Subish P, Bhandari RB, Das B. Drug utilisation among older inpatients in a teaching hospital in Western Nepal. Singapore Med J. 2010;51(1):28-34.

Zaveri HG, Mansuri SM, Patel VJ. Use of potentially inappropriate medicines in elderly: a prospective study in medicine out-patient department of a tertiary care teaching hospital. Indian J Pharmacol. 2010;42:95-8.

Shah RB, Gajjar BM, Desai SV. Evaluation of the appropriateness of prescribing in geriatric patients using beers criteria and phadke’s criteria and comparison thereof. J Pharmacol Pharma Co The R. 2011;2(4):248-52.

Shankar PR, Upadhyay DK, Subish P, Bhandari RB, Das B. Drug utilisation among older inpatients in a teaching hospital in Western Nepal. Singapore Med J. 2010; 51(1):28-34.

Jhaveri BN, Patel TK, Barvaliya MJ, Tripathi CB. Drug utilization pattern and pharmacoeconomic analysis in geriatric medical in-patients of a tertiary care hospital of India. J Pharmacol Pharmacother. 2014;5(1):15-20.

Razavi M, Meera NK, Karimian H, Khajuria DK. A profile of drug utilization among elderly inpatients admitted at a tertiary level hospital in Bangalore: a prospective study. Archives of Pharmacy Practice. 2012;3(3):217-22.