Choosing Wisely:

Don’t prescribe a medication without conducting a drug regimen review.

Rationale and Comments: Older patients disproportionately use more prescription and nonprescription drugs than other populations, increasing the risk for side effects and inappropriate prescribing. Polypharmacy may lead to diminished adherence, adverse drug reactions and increased risk of cognitive impairment, falls, and functional decline. Medication review identifies high-risk medications, drug interactions, and those continued beyond their indication. Additionally, medication review elucidates unnecessary medications and underuse of medications, and may reduce medication burden. Annual review of medications is an indicator for quality prescribing in vulnerable elderly.
Sponsoring Organizations:
  • American Geriatrics Society
  • Sources:
  • Expert consensus
  • Disciplines:
  • Geriatric Medicine
  • References: • National Committee for Quality Assurance. Improving quality and patient experience – the state of health care quality 2013. Washington (DC): National Committee for Quality Assurance; 2013 Oct. 206 p.
    • Shrank WH, Polinski JM, Avorn J. Quality indicators for medication use in vulnerable elders. J Am Geriatr Soc. 2007;55 (suppl 2):S373–82.
    • Hajjar ER, Cafiero AC, Hanlon JT. Polypharmacy in elderly patients. Am J Geriatr Pharm. 2007 Dec;5(4):345–51.
    • Steinman MA, Hanlon JT. Managing medications in clinically complex elders: “There’s got to be a happy medium.” JAMA. 2010 Oct 13;304(14):1592–1601.
    • Drenth-van Maanen AC, van Marum RJ, Knol W, van der Linden CM, Jansen PA. Prescribing optimization method for improving prescribing in elderly patients receiving polypharmacy. Drugs Aging. 2009;26(8):687–701.

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