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.
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