Appropriate proton pump inhibitor use among older adults: A retrospective chart review

Background: Proton pump inhibitors (PPIs) are widely used, but not always with a clear indication. Nonindicated use is of particular concern among older adults, who may have multiple comorbidities and take more medications, increasing their risk for adverse drug reactions. Objective: This study examined the appropriateness of PPI use at an outpatient geriatric practice and the association between particular patient characteristics and appropriate use of these medications. Methods: This was a retrospective chart review of a group of randomly identified community-dwelling adults aged ≥65 years with a current prescription for a PPI (as of August 2006) from a geriatric ambulatory care practice within an urban academic medical center. The main outcome was appropriateness of PPI use, categorized as indicated, possibly indicated, or not indicated, based on US Food and Drug Administration-approved indications and national gastroenterology guidelines. Results: Out of ~2500 patients in the geriatric practice, 702 (~28%) were identified as having a current prescription for a PPI. From these, 110 charts were randomly selected for review, of which 10 were excluded based on predefined criteria. The sample was 79% female and 46% white, with a mean age of 82.8 years (range, 66-99 years). PPI use was indicated in 64% of these patients, possibly indicated in 7%, and not indicated in 29%. Compared with indicated PPI use, nonindicated use was significantly associated with use for <1 year (relative risk = 2.20; 95% CI, 1.00-4.86; P = 0.05). Nonindicated PPI use was not significantly associated with age, female sex, nonwhite race, or PPI initiation in the inpatient setting. Conclusion: Almost 30% of patients receiving a PPI in this academic geriatric practice had no documented indication for PPI use.