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With an ageing population, safe medication use in older people is becoming even more important. Older people are widely acknowledged to be at higher risk of medication-related problems, and it may be argued that those with chronic renal disease are particularly at risk, as many medications require dose reduction or should be avoided completely in these cases. Jones and Bhandari1 report the prevalence of potentially inappropriate prescribing in 100 older people with chronic renal disease admitted to the medical admissions unit of an English teaching hospital. They report that more than half of these patients were prescribed at least one potentially inappropriate medication, and that 13% of 622 prescribed drugs were potentially inappropriate. The authors indicate that this prevalence is high, and action is therefore required. This raises a number of questions. What does ‘potentially inappropriate’ actually mean? How should inappropriate medication be identified? Are patients with chronic renal disease more at risk? And, most importantly, what action, if any, is needed?
First, what does ‘potentially inappropriate’ mean in practice, and why does it matter? Medication that is inappropriate is usually taken to mean medication that is either ineffective or poses an unnecessary risk compared with other options available. However, to explore this in more detail, we also need to consider the next question, concerning methods used for identifying inappropriate medication.
In relation to the second question, two broad approaches to identifying inappropriate medication exist: these are often referred to as ‘implicit’ and ‘explicit’ methods. Implicit methods rely on expert judgement and are potentially more subjective …