Potentially Inappropriate Prescribing for Prostatic Hyperplasia in Older Persons
Résumé
Objectives: In the context of improved medication management of older patients, we wished to evaluate the overprescription of potentially inappropriate drugs [α1-blockers and 5α-reductase inhibitors (5-ARI)] for benign prostate hyperplasia (BPH). These drugs are considered by geriatricians to increase the risk of falls and pharmacodynamic interactions, but these properties have not yet been proven. Design: This was a descriptive study of drug prescriptions in a geriatric academic center. Setting and Participants: We included all patients older than 75 years who received a prescription for α1-blockers or 5-ARIs for 2 weeks in our hospital. Methods: We evaluated the prevalence of the potentially inappropriate prescription of α1-blockers and 5-ARI in older people during hospitalization using a new tool consisting of an 8-item list of explicit indicators developed using the most recent summary of product characteristics (SmPC) and latest European Association of Urology (EAU) guidelines. Results: A population of 117 patients (≥q75 years) was included in the study. The median age was 84.5 (±6.3) years. The average time since urological medication prescription was 1.2 ± 1.6 years. According to explicit criteria, 84 patients (71.8%) received at least 1 potentially inappropriate urologic medication, 77 (91.7%) related to α1-blockers. Patients with a potentially inappropriate prescription for α1-blockers and/or 5-ARIs more frequently had urological assessments (P =.026), more frequently showed pharmacological interactions, with the risk of orthostatic hypotension (P =.005) or arrhythmia (P =.028), and experienced more falls in their history (P =.043). The misuse group was associated with an increased risk of falls, with an odds ratio of 3.22 (P =.039, 95% confidence interval 1.08\textendash 10.2). Conclusions and Implications: In our study, potentially inappropriate prescriptions for older individuals for BPH was close to 72% and mainly involved α1-blockers. Potentially inappropriate prescriptions for BPH were associated with a threefold higher frequency of falls. \textcopyright 2021 AMDA \textemdash The Society for Post-Acute and Long-Term Care Medicine