Potentially inappropriate prescribing before and after nursing home admission among patients with and without dementia (original) (raw)
Scandinavian Journal of Primary Health Care, 2012
Objective. To identify inappropriate prescribing among older patients on admission to and discharge from an intermediatecare nursing home unit and hospital wards, and to compare changes during stay within and between these groups. Design. Observational study. Setting and subjects. Altogether 400 community-dwelling people aged Ն 70 years, on consecutive emergency admittance to hospital wards of internal medicine and orthopaedic surgery, were randomized to an intermediatecare nursing home unit or hospital wards; 290 (157 at the intermediate-care nursing home unit and 133 in hospital wards) were eligible for this sub-study. Main outcome measures. Prevalence on admission and discharge of potentially inappropriate medications (Norwegian general practice [NORGEP] criteria) and drug -drug interactions; changes during stay. Results. The mean (SD) age was 84.7 (6.2) years; 71% were women. From admission to discharge, the mean numbers of drugs prescribed per person increased from 6.0 (3.3) to 9.3 (3.8), p Ͻ 0.01. The prevalence of potentially inappropriate medications increased from 24% to 35%, p Ͻ 0.01; concomitant use of Ն 3 psychotropic/opioid drugs and drug combinations including non-steroid anti-infl ammatory drugs (NSAIDs) increased signifi cantly. Serious drug -drug interactions were scarce both on admission and discharge (0.7%). Conclusions. Inappropriate prescribing was prevalent among older people acutely admitted to hospital, and the prevalence was not reduced during stay at an intermediate-care nursing home unit specially designed for these patients.
Revista Española de Geriatría y Gerontología, 2023
OBJECTIVE: To assess the quality of medication prescribing in ambulatory elderly patients on multiple medications using the Medication Appropriateness Index (MAl). DESIGN: Cross-sectional study. SETTING: General Medical Clinic of the Durham VA Medical Center. PATIENTS: 208 elderly outpatients on five or more regularly scheduled medications. MEASUREMENTS: Medication prescribing appropriateness was measured with the MAl, a reliable method that employs 10 implicit criteria. A weighted MAl score (range 0-18 per drug) served as a summary measure of appropriateness. RESULTS: There were 1644 medications evaluated; 26% received no inappropriate ratings, 37% had one, 19% had two, and 18% had three or more. Of 16,440 ratings, 2295 (14%) were evaluated as inappropriate. The percentage of inappropriate ratings varied across prescribing dimensions: drug-drug interactions, 00/0; drug-disease interactions, 1.4%; medication effectiveness, 4.7%; therapeutic duplication, 5.7%; indication, 11.50/0; duration of treatment, 16.5%; dosage, 17.3%; practical directions, 20.3%; cost, 29.7%; and correct directions, 32.4%. The mean MAl score for all medications was 2.2 ± 2.1 (range 0-10) and varied by therapeutic class. MAl scores were significantly lower for medications with a high potential for adverse effects compared with those with a low potential (MAl score of 1.8 vs 2.9, P < 0.001). Regression analysis revealed that no patient characteristics were associated with a higher likelihood of inappropriate prescribing. CONCLUSIONS: Medication prescribing for elderly outpatients taking multiple medications was substantially appropriate. Prescribing dimensions with the most room for
Journal of the American Medical Directors Association, 2022
Objectives:To summarize current evidence regarding facility and prescriber characteristics associated with potentially harmful medication (PHM) use by residents in nursing homes (NHs), which could inform the development of interventions to reduce this potentially harmful practice.Design:Scoping review.Setting and Participants:Studies conducted in the United States that described facility and prescriber factors associated with PHM use in NHs.Methods:Electronic searches of PubMed/MEDLINE were conducted for articles published in English between April 2011 and November 2021. PHMs were defined based on the Beers List criteria. Studies testing focused interventions targeting PHM prescribing or deprescribing were excluded. Studies were characterized by the strengths and weaknesses of the analytic approach and generalizability.Results:Systematic search yielded 1253 articles. Of these, 29 were assessed in full text and 20 met inclusion criteria. Sixteen examined antipsychotic medication (APM) use, 2 anticholinergic medications, 1 sedative-hypnotics, and 2 overall PHM use. APM use was most commonly associated with facilities with a higher proportion of male patients, younger patients, and patients with severe cognitive impairment, anxiety, depression, and aggressive behavior. The use of APM and anticholinergic medications was associated with low registered nurse staffing ratios and for-profit facility status. No studies evaluated prescriber characteristics.Conclusions and Implications:Included studies primarily examined APM use. The most commonly reported facility characteristics were consistent with previously reported indicators of poor NH quality and NHs with patient case mix more likely to use PHMs.
Inappropriate Medication Prescribing in Residential Care/Assisted Living Facilities
Journal of the American Geriatrics Society, 2000
To identify the extent to which inappropriately prescribed medications (IPMs) are administered to older patients in residential care/assisted living (RC/AL) facilities and to describe facility and resident factors associated with receipt of one or more IPMs. DESIGN: Cross-sectional study of a stratified, representative sample of 193 facilities in four states. SETTING: We identified representative geographic regions within Florida, New Jersey, North Carolina, and Maryland and drew from within them a stratified random sample of 193 RC/AL facilities. Three subtypes of facilities were included in the sample: small homes ( Ͻ 16 beds), larger "new-model" homes, and larger "traditional" homes. PARTICIPANTS: Within each larger home, a random sample of residents aged 65 and older was approached for consent; in smaller homes all residents were approached. The overall enrollment rate was 92%; 2,078 residents were enrolled. MEASUREMENTS: Questionnaires and on-site observations were used to gather data on facility administration and staffing and resident characteristics. All prescription and nonprescription medications taken at least 4 of the 7 days before data collection were taken from medication administration records and coded for analysis. IPM designation was based on modification of a list developed by Beers et al. and currently used by nursing home surveyors. RESULTS: The majority of RC/AL patients were taking five or more medications; 16.0% of these patients were receiving IPMs. The most common IPMs were oxybutynin, propoxyphene, diphenhydramine, ticlopidine, doxepin, and dipyridamole. In multivariate analyses, using generalized estimating equations, IPM use was associated with the number of medications received, smaller facility bed size, moderate licensed practical nurse turnover, absence of dementia, low monthly fees, and absence of weekly physician visits. CONCLUSIONS: IPMs remain a problem in long-term care, but rates in these RC/AL settings compare favorably with those reported for other frail older populations, suggesting that use of medications with severe adverse effects may be waning. Regular physician facility visits may improve prescribing, as will attention to high-risk groups such as individuals on multiple medications.
Medication prescribing and administration in nursing homes
Age and Ageing, 1998
Objective: to examine the key determinants of pharmaco-epidemiology in Australian nursing homes. Design: a cross-sectional survey of medication use in 998 residents in 15 nursing homes in Southern Queensland and Northern New South Wales. Results: the total, laxative, digoxin/diuretic, benzodiazepine and psycholeptic medication prescribed and administered to residents of nursing homes was affected to differing extents by age and gender, the nursing home, resident functional disability and medical practitioner. Resident Classification Instrument (RCI) category and nursing home were the dominant determinants for prescribing and administration of the total drugs, laxative, benzodiazepine and psycholeptic medications. In contrast, the resident use of digoxin and/or diuretics was dependent on the resident age and on the functional disability (RCI category) of the resident but not medical practitioner or nursing home. Approximately 30% of medications were prescribed on a pro re nata (p.r.n.) basis and administered at the discretion of registered nurses. Conclusion: nursing home culture is a major determinant of the variability in medication use between residents, particularly for those medications often prescribed for p.m. use. The nursing home does not account for variation in the use of digoxin and/or diuretics which are prescribed on a non-discretionary basis. O 3 oo sO 3
The risk of drug-related negative outcomes is a relevant issue, especially in older persons. n The risk of potentially inappropriate prescribing (PIP) is particularly high and worrisome in nursing home (NH) residents. n Different criteria have been developed to define and identify PIP in elderly patients with the aim of reducing the use of medications with unfavourable benefit-risk ratio. WHAT THIS STUDY ADDS n A reduction in total number of PIP was observed after NH admission. n However, the prevalence of PIP appears to be higher than expected, particularly for residents being prescribed with warfarin in combination with NSAIDs, and for residents prescribed with NSAIDs despite a diagnosis of heart failure. n More efforts need to be made considering the persistence of PIP after NH admission.
Potentially Inappropriate Prescribing in Older People with Dementia in Care Homes
Drugs & Aging, 2012
Background: Older people in general and care home residents in particular are at high risk of suboptimal or inappropriate prescribing. To date, research into potentially inappropriate prescribing (PIP) has not focused on care home residents and/or has not utilized the recently developed and validated Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria. Objective: The aim of this study was to estimate the prevalence of PIP in older people with dementia living in six residential care homes in England, using the STOPP criteria. Methods: A retrospective analysis was conducted using medication data collected for older people with dementia in six residential care homes in England who participated in the prospective, longitudinal EVIDEM -End of Life (EoL) study. Of the 133 residents recruited to the study, medication administration records were available for and reviewed at two timepoints (approximately 16 weeks apart) for 119 residents and 110 residents, respectively. The prevalence of PIP at these timepoints was determined using 31 of the 65 STOPP criteria applicable when there is no access to residents' medical records. Results: At the first timepoint, 68 potentially inappropriate medications (PIMs) were identified. Fifty-five residents (46.2%) were prescribed one or more PIM(s), eleven (9.2%) were prescribed two or more PIMs and two (1.7%) were prescribed three PIMs. Thirteen of the 31 STOPP criteria utilized in this study (41.9%) were used to identify PIP. Long-term (i.e. >1 month) neuroleptics (antipsychotics) were the most frequently prescribed PIMs (n = 25; 21.0%), followed by non-steroidal anti-inflammatory drugs (NSAIDs) for >3 months, proton pump inhibitors (PPIs) at maximum therapeutic
Medication use in nursing home residents with advanced dementia
International Journal of Geriatric Psychiatry, 2008
Objective To describe medication usage in nursing home residents with advanced dementia, to identify how this usage changed as patients advanced towards death, and to identify correlates of increased medication usage. Methods Prospective cohort study (CareAD) during which data on medication prescription were extracted from medical records at regular intervals using standardized extraction procedures. Results Patients (n ¼ 125) were prescribed a mean of 14.6 medications during the 6 months prior to study enrollment. In a subgroup of patients who died during the study (n ¼ 88), as the time of death approached, the total number of medications prescribed did not vary but the types of medications prescribed did change, with an increase in palliative medications such as opiate analgesics and a decrease in other medication classes such as antibiotics, anti-dementia agents, cardiovascular agents, and psychotropic agents, among others. In linear regression analyses, total medication prescription at study entry was associated with study site, antibiotic treatment, presence of cardiovascular disease, and treatment of gastrointestinal or dermatological conditions. Conclusions Nursing home residents with advanced dementia are prescribed a large number of medications from numerous medication classes and prescribing patterns change over time. Further study is needed to determine the ideal approach to treating chronic medical problems at the end of life in this patient population.
The Annals of pharmacotherapy, 2014
The frequency of prescribing potentially inappropriate medications (PIMs) in older patients remains high despite evidence of adverse outcomes from their use. Little is known about whether admission to hospital has any effect on appropriateness of prescribing. This study aimed to identify the prevalence and nature of PIMs and explore the association of risk factors for receiving a PIM. This was a prospective study of 206 patients discharged to residential aged care facilities from acute care. All patients were at least 70 years old and were admitted between July 2005 and May 2010; their admission and discharge medications were evaluated. Mean patient age was 84.8±6.7 years; the majority (57%) were older than 85 years, and mean (SD) Frailty Index was 0.42 (0.15). At least 1 PIM was identified in 112 (54.4%) patients on admission and 102 (49.5%) patients on discharge. Of all medications prescribed at admission (1728), 10.8% were PIMs, and at discharge, of 1759 medications, 9.6% were PI...