Trends in potentially inappropriate prescribing amongst older UK primary care patients

Purpose: To examine trends in UK primary care prescribing of medications potentially inappropriate for older people in the context of published international data. Methods: Analysis of routinely collected anonymised computerised patient records in 131 UK general practices (approximately 162 000 registered patients annually aged ≥65 years) providing data to the DIN-LINK database between 1994 and 2003. In each year, we identified patients prescribed drugs classified by the 2003 Beers criteria as potentially inappropriate for older people. Results: The level of potentially inappropriate prescribing remained steady over time: in 2003 32.2% of patients received any Beers drug, and 20.5% received a drug categorised as potentially "high risk"; percentages had been 32.9% and 21.4% respectively in 1994. In 2003, co-proxamol (93.7/1000 patients), benzodiazepines (52.4/1000 patients) and amitriptyline (45.4/1000, mainly at low doses) were the most frequently prescribed potentially inappropriate drugs. If co-proxamol (now being withdrawn) and low-dose amitriptyline (appropriate for neuropathic pain) are excluded, 24.8% of patients still received a potentially inappropriate prescription in 2003. Conclusions: Prescription of potentially inappropriate medication, particularly benzodiazepines, to older people remains at a high level in the UK. Levels were higher than those seen in published data from the Netherlands, however the low rate of co-proxamol prescribing in the Netherlands explains much, but not all, of the difference. Future international comparisons, based on more careful delineation of the criteria, may play a valuable role in pharmaco-vigilance and can identify areas where regulation of prescribing may reduce risks to older patients.