Abstract
BackgroundCare home residents often have multiple cognitive and physical impairments, and are at high risk of adverse drug events (ADEs).AimTo describe excessive polypharmacy and potentially inappropriate prescribing predisposing care home residents to ADEs.Design & settingA cross-sectional analysis of all dispensed prescriptions for 147 care home residents in Tayside and Fife, Scotland.MethodPrevalence of excessive polypharmacy was examined using multilevel logistic regression, by modelling associations between individual and care home predictors with excessive polypharmacy (≥10 drugs). Prescribing of drugs known to increase the risk of eight clinically important ADE categories was examined. Drugs prescribed within each ADE category, for each resident, were counted.ResultsIn total, 32.3% (n = 1444/4468) of residents had excessive polypharmacy, which was more common in residents aged 70–74 years (adjusted odds ratio [aOR] 1.86, 95% confidence interval [CI] = 1.04 to 3.34) and 80–84 years (aOR 1.75, 95% CI = 1.01 to 3.02), living in a residential care home (aOR 1.50, 95% CI = 1.19 to 1.88), and located in Fife (aOR 1.37, 95% CI = 1.09 to 1.71). Excessive polypharmacy was less common in residents with dementia (aOR 0.73, 95% CI = 0.64 to 0.84), and 8.9% (95% CI = 5.9% to 11.6%) of the variation was attributable to care home predictors. Potentially inappropriate prescribing of ≥2 drugs was seen across all ADE categories, with highest prevalence seen in drugs predisposing to constipation (35.8%), sedation (27.7%), and renal injury (18.0%).ConclusionExcessive polypharmacy is common in care home residents and is associated with both individual and care home predictors. Potentially inappropriate prescribing of drugs that predisposed residents to all included ADE categories is common. Research is needed to support and evaluate safe care home prescribing practices.
Highlights
Care home residents are often older adults who are frail, with complex care needs owing to multiple cognitive and physical impairments.[1]
Excessive polypharmacy was less common in residents with dementia, and 8.9% of the variation was attributable to care home predictors
Inappropriate prescribing of ≥2 drugs was seen across all adverse drug events (ADEs) categories, with highest prevalence seen in drugs predisposing to constipation (35.8%), sedation (27.7%), and renal injury (18.0%)
Summary
Care home residents are often older adults who are frail, with complex care needs owing to multiple cognitive and physical impairments.[1]. Count definitions are common where prescribing of ≥5 and ≥10 different drugs define polypharmacy and excessive polypharmacy, respectively.[7,8] Other definitions focus on the appropriateness of polypharmacy (where all drugs are prescribed for the purpose of achieving specific therapeutic objectives and therapy has been optimised to reduce the risk of ADEs), irrespective of count. Polypharmacy is likely inappropriate when ≥1 drugs are prescribed that were never strongly indicated, where the indication has expired, or where one or a combination of drugs put the person at an unacceptably high risk of an ADE. Care home residents often have multiple cognitive and physical impairments, and are at high risk of adverse drug events (ADEs)
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