Eur J Clin Pharmacol (2005) 61: 913–919 DOI 10.1007/s00228-005-0036-4 PHARMACOEPIDEMIOLOGY AND PRESCRIPTION Laurent Azoulay . Amir Zargarzadeh . Zeinab Salahshouri . Driss Oraichi . Anick Bérard Inappropriate medication prescribing in community-dwelling elderly people living in Iran Received: 29 April 2005 / Accepted: 31 August 2005 / Published online: 24 November 2005 # Springer-Verlag 2005 Abstract Objectives: To determine the prevalence of inappropriate medication prescribing in Middle Eastern community-dwelling elderly persons, and to determine factors associated with inappropriate prescribing. Methods: Pre- scriptions from 3,000 elderly-patient visits (≥65 years) to physicians in Isfahan, Iran were collected between September and December 2002; only the first patient visit was considered in the study. Inappropriate prescriptions were defined ac- cording to Beers’ explicit criteria (1997). The presence of at least one drug–drug interaction (DDI) and at least one drug- class duplication within each patient visit was also determined. Multivariate analyses were performed to determine factors associated with receiving at least one inappropriate medica- tion. These factors included age, gender, number of prescribed medications per visit, DDIs, duplications, and physician’ s number of years of experience. Similar analyses were performed to determine whether these factors were associated with a composite index (defined as having at least one of the following: receiving at least one inappropriate prescription, DDI, or duplication). Results: The mean age of our cohort was 72.6 (±5.7) years, and 1,735 (57.8%) were females. A total of 829 (27.6%) patients received at least one inappropri- ate prescription, 285 (9.5%) had at least one DDI during the visit, and 746 (24.9%) had at least one duplication during the visit. The three most inappropriately prescribed medication classes were antihistamines (29%), non-steroidal anti-inflam- matory agents (23%) and benzodiazepines (16%). In multi- variate analyses, the number of prescribed medications per visit was the only factor significantly associated with receiving at least one inappropriate prescription (OR 1.24; 95%CI: 1.16–1.32); analyses using the composite index as outcome gave similar results (OR: 1.70; 95%CI: 1.60–1.80). Conclusion: Our findings indicate a high prevalence of inappropriate prescribing in elderly patients. Given the potential severity of this problem, further steps need to be implemented to prevent this occurrence. Introduction Inappropriate medication prescribing to the elderly is a major public health concern. The risk/benefit ratio of certain medications is adversely affected by age-related changes in pharmacokinetics and pharmacodynamics [1, 2]. As a result, elderly patients are at a greater risk of drug- related morbidity and mortality. Inappropriate medications have been defined as those for which the risks outweigh the benefits [3, 4]. In the last decade, the development of explicit criteria for inappropriate medications has become an important tool in evaluating prescribing in elderly populations. Through a consensus panel of 13 experts in pharmacology, pharma- coepidemiology, clinical geriatric pharmacology and long- term care, Beers [3] developed criteria for inappropriate medication use in nursing-home residents. These criteria have helped set a consistent and explicit measure of inappropriate medication prescribing and use. Although developed for a nursing-home population, these criteria have been modified and used in various settings [4–10]. In 1997, Beers [11] updated and expanded the criteria to include new information, such as a severity rating, med- ications inappropriate for patients with certain medical This study was presented at the Canadian Association for Population Therapeutics held in Winnipeg, Canada, June 6–8, 2004, and at the 20th International Conference on Pharmacoepidemiology and Therapeutic Risk Management held in Bordeaux, France, August 22–25, 2004. L. Azoulay . A. Bérard Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada L. Azoulay . D. Oraichi . A. Bérard (*) Research Centre, Sainte-Justine Hospital, 3175, Chemin de la Côte-Ste-Catherine, Montreal, Quebec, H3T 1C5, Canada e-mail: anick.berard@umontreal.ca Tel.: +1-514-3454931 Fax: +1-514-3454801 A. Zargarzadeh . Z. Salahshouri School of Pharmacy, Isfahan University of Medical Sciences, Isfahan, I.R., Iran