Abstract
BackgroundIt has been estimated that Nursing Home (NH) residents with impaired cognitive status receive an average of seven to eight drugs daily. The aim of this study was to determine prevalence and factors associated with use of inappropriate drugs in elderly patients with severe cognitive impairment living in NH in Europe.MethodsCross-sectional data from a sample of 1449 NH residents with severe cognitive impairment, participating in the Services and Health for Elderly in Long TERm care (SHELTER) study were analysed. Inappropriate drug use was defined as the use of drugs classified as rarely or never appropriate in patients with severe cognitive impairment based on the Holmes criteria published in 2008.ResultsMean age of participating residents was 84.2±8.9 years, 1087 (75.0%) were women. Inappropriate drug use was observed in 643 (44.9%) residents. Most commonly used inappropriate drugs were lipid-lowering agents (9.9%), antiplatelet agents (excluding Acetylsalicylic Acid – ASA –) (9.9%), acetylcholinesterase, inhibitors (7.2%) and antispasmodics (6.9%). Inappropriate drug use was directly associated with specific diseases including diabetes (OR 1.64; 95% CI 1.21–2.24), heart failure (OR 1.48; 95% CI 1.04–2.09), stroke (OR 1.43; 95% CI 1.06–1.93), and recent hospitalization (OR 1.69; 95% CI 1.20–2.39). An inverse relation was shown between inappropriate drug use and presence of a geriatrician in the facility (OR 0.55; 95% CI 0.39–0.77).ConclusionUse of inappropriate drugs is common among older EU NH residents. Determinants of inappropriate drug use include comorbidities and recent hospitalization. Presence of a geriatrician in the facility staff is associated with a reduced rate of use of these medications.
Highlights
Dementia is a common condition in institutionalized older adults: it has been estimated that in the United States (US) 50% of Nursing Home (NH) residents have a diagnosis of dementia and the majority of them are affected by other chronic diseases [1]
Residents on inappropriate drugs were more likely to have experienced a recent hospitalization and less likely to live in a facility which included a geriatrician among staff relative to those receiving appropriate treatment
With regard to appropriateness of drugs prescription according to cognitive performance scale (CPS) score, Figure 1 shows that the prevalence of rarely appropriate and never appropriate drug prescription varied according to CPS score (p,0.001)
Summary
Dementia is a common condition in institutionalized older adults: it has been estimated that in the United States (US) 50% of Nursing Home (NH) residents have a diagnosis of dementia and the majority of them are affected by other chronic diseases [1] In this population, dementia represents a life-defining disease, in which many physical and psychological symptoms proceeded by a prolonged terminal phase might influence quality of life. Memory loss, decline in intellectual function and impaired judgment and language, commonly observed in patients with advanced dementia, have obviously negative impact on decision making capacity, influence treatment adherence, and may cause communication difficulties including a decreased ability to report adverse effects [5,6] For this reason the use of drugs to treat non-dementia illnesses in older adults with severe cognitive impairment might be questionable and may lead to serious adverse effects, even when clearly beneficial drugs recommended by clinical guidelines are prescribed [5].
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