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March 13, 2002

Inappropriate Prescribing for Elderly Patients

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor

JAMA. 2002;287(10):1264-1265. doi:10.1001/jama.287.10.1261

To the Editor: In his Editorial about inappropriate prescription of drugs for elderly patients, Dr Avorn1 implied that a now well known list of contraindicated drugs2 can be used to study this phenomenon. Granted, most physicians would agree that propoxyphene and many of the other medications on this list are not optimal choices for elderly patients. However, this approach overlooks the possibility that appropriate medications used inappropriately are at least as dangerous as inappropriate medications used at all. Nonetheless, we agree with Avorn that it is time to stop describing the problem and start doing something about it, and that "a higher standard is needed." What Avorn has overlooked is that such a higher standard exists. The Medication Appropriateness Index (MAI), which can be used to evaluate the appropriateness of medication use in individual patients,3,4 has been found to improve the appropriateness of medication prescribing and possibly reduce adverse drug events without affecting health-related quality of life.5 If the MAI, or even the implicit principles behind it, were used broadly, some of these goals could be realized.