Defining inappropriate practices in prescribing for elderly people

Table 4: Inappropriate practices in prescribing miscellaneous drugs for elderly people
Practice	Mean clinical significance rating	Risk to patient	Alternative therapy	% of panel members who agreed with alternative
Prescription of cimetidine to treat peptic ulcer for patients already receiving warfarin	3.47	May inhibit warfarin metabolism and increase the risk of bleeding	Other histamine (H2)-receptor antagonist	84
Prescription of anticholinergic or antispasmodic drugs to treat irritable bowel syndrome for patients with dementia	3.41	May worsen cognitive and behavioural function	Nondrug and diet therapy, calcium-channel blocker to treat diarrhea	69
Prescription of dipyridamole to prevent stroke	3.30	Ineffective	ASA Ticlopidine	94 69
Long-term prescription of orally administered steroids to treat COPD for patients with a history of NIDDM*	3.25	May worsen NIDDM	Inhaled steroids and bronchodilators with monitoring of blood glucose levels	97
Prescription of anticholinergic drugs to prevent extrapyramidal effects of antipsychotic drugs	3.16	May cause agitation, delirium and impaired cognition	Decreased dosage of antipsychotic drugs or reassessment of need for these drugs	97
Long-term prescription of diphenoxylate to treat diarrhea	3.13	Drowsiness, cognitive impairment and dependence	Nondrug and diet therapy or loperamide	84
Prescription of cyclobenzaprine or methocarbamol to treat muscle spasms	3.06	Drowsiness, agitation and disorientation	Nondrug therapy (physiotherapy, application of heat and cold or TENS†)	94
*NIDDM = non-insulin-dependent diabetes mellitus. †TENS = transcutaneous electrical nerve stimulation.

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