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Underprescription of Beneficial Medicines in Older People

Causes, Consequences and Prevention

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Abstract

Underprescription of potentially useful drugs is widespread among older people and may herald several adverse outcomes. We aimed to review the evidence pertaining to the epidemiology, causes and consequences of underprescribing, as well as recent advances in the development of interventions able to reduce underprescribing and improve outcomes in older people.

Underprescribing is highly prevalent across different settings, including in the community, hospitals and nursing homes. Multimorbidity, polypharmacy, ageism, lack of scientific evidence, fear of adverse events and economic problems may contribute to the underprescription of indicated drugs, although in some patients, a limited life expectancy, the lack of a favourable risk-to-benefit ratio or a patient’s refusal might represent appropriate reasons not to prescribe a drug.

Selected interventions may help to improve the quality of prescriptions and reduce the burden of underprescribing. Among these, comprehensive geriatric assessment (CGA) has been demonstrated to effectively improve prescribing practice. Interventions based on service delivery changes, such as those that include a clinical pharmacist or a case manager in the process of care, were also found to improve the quality of pharmacological prescriptions. Educational interventions may also be effective in reducing underprescribing.

More recently, the clinical application of the Screening Tool to Alert Doctors to Right Treatment (START) criteria has been able to significantly reduce underprescribing. Since START criteria are easier to apply in clinical practice than other instruments, it is conceivable that their systematic use may contribute to reducing underprescribing and to improving health outcomes in older patients.

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Acknowledgements

Antonio Cherubini and Andrea Corsonello contributed equally to this work.

All authors declare to have no conflicts of interest regarding this manuscript. No sources of funding were used to assist in the preparation of this article.

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Authors and Affiliations

  1. Italian National Research Centres on Aging (INRCA), Geriatric Hospital, via della Montagnola, Ancona, 60100, Italy

    Antonio Cherubini MD, PhD

  2. Institute of Gerontology and Geriatrics, University of Perugia Medical School, Perugia, Italy

    Antonio Cherubini MD, PhD

  3. Unit of Geriatric Pharmacoepidemiology, Italian National Research Centre on Aging (INRCA), Cosenza, Italy

    Andrea Corsonello

  4. Scientific Direction, Italian National Research Centres on Aging (INRCA), Ancona, Italy

    Fabrizia Lattanzio

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  1. Antonio Cherubini MD, PhD
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  2. Andrea Corsonello
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  3. Fabrizia Lattanzio
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Correspondence to Antonio Cherubini MD, PhD.

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Cherubini, A., Corsonello, A. & Lattanzio, F. Underprescription of Beneficial Medicines in Older People. Drugs Aging 29, 463–475 (2012). https://doi.org/10.2165/11631750-000000000-00000

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