Drug-related problems in the frail elderly.

Drug-related problems in the frail elderly As pharmacists and physicians working in a geriatric day hospital (GDH), we read with interest your November 2010 issue, which covered aspects of care of the elderly, and greeted with enthusiasm the initiative to describe approaches to common geriatric problems.1 We would like to reinforce the need to consider the importance of medication assessment and iatrogenic illness in caring for the frail elderly. A recent review of 51 medication-assessment consultations completed in our GDH found that our patients (average age 81 years; 39 women and 12 men) were each taking an average of 15 medications (range 6 to 28), with 8.9 drug-related problems per patient identified (range 3 to 19). As Figure 1 shows, patients were commonly taking medications no longer needed and experiencing drugrelated adverse effects. Medications commonly found to be no longer needed included the following: acetylsalicylic acid, furosemide, antihypertensives, proton pump inhibitors, and iron. Benzodiazepines were commonly associated with adverse reactions. We found a positive correlation between numbers of medications and numbers of drug-related problems, but did not find such a correlation for age or renal function. A similar study conducted in 1999 for 46 medication-assessment consultations in the GDH described 6.3 drug-related problems per patient, possibly suggesting that the incidence of drug-related problems has increased over time in this population. Polypharmacy is common in the elderly with reported average medication numbers ranging from 8 to 13, and average numbers of drug-related problems ranging from