Abstract
BackgroundFrail residents in the nursing home sector call for extra care in prescribing. The Norwegian General Practice Nursing Home (NORGEP-NH) list of 34 explicit criteria for potentially inappropriate medication use in nursing homes was developed explicitly for this population. The aim of this study was to employ the NORGEP-NH Criteria to study the extent of potentially inappropriate medication use among nursing home residents and explore possible associated factors.MethodsCross-sectional observational pharmacoepidemiological study from residents in nursing homes in the county of Vestfold, Norway. Data collected 2009–11 included residents’ demographic and clinical status and all medications, regular and on demand.Results881 patients from 30 institutions (mean 85.9 years, 68.6% female), were included. According to NORGEP-NH, 43.8% were prescribed at least one potentially inappropriate regular medication, and 9.9% regularly received three or more potentially inappropriate medications. When also including a) the NORGEP-NH Deprescribing Criteria and b) including drugs prescribed for use as needed, 92.7% of all residents received medication that needs particular surveillance according to the NORGEP-NH. 69.7% of the nursing home residents used at least one psychotropic drug regularly. Female residents received more often than males at least one potentially inappropriate regular medication (OR 1.60, p=0.007). Regarding the prescription of three or more concomitant psychotropic medications, odds ratio for females was 1.79 (p=0.03) compared to males. Residents with the best performance in activities of daily living, and residents residing in long-term wards, had higher risk of using three or more psychotropic drugs. Use of multiple psychoactive drugs increased the risk of falls in the course of an acute episode of infection or dehydration (odds ratio 1.70, p=0.009).ConclusionsPrevalence of potentially inappropriate medications in nursing homes according to the NORGEP-NH was extensive, and especially the use of multiple psychotropic drugs. The high prevalence found in this study shows that there is a need for higher awareness of medication use and side effects in the elderly population.Trial registrationRetrospectively registered. Data obtained from clinical trial NCT01023763 registered with ClinicalTrials.gov 12/01/2009.
Highlights
Frail residents in the nursing home sector call for extra care in prescribing
The situation is similar in Norway, where a recent study found that the prevalence of dementia among Norwegian nursing home residents increased from 80.4% in 2004 to 84.3% in 2010–11
When including pro re nata (PRN) drugs, the percentage of residents affected by at least one potentially inappropriate medication (PIM) rose to 69.9%
Summary
Frail residents in the nursing home sector call for extra care in prescribing. The Norwegian General Practice Nursing Home (NORGEP-NH) list of 34 explicit criteria for potentially inappropriate medication use in nursing homes was developed explicitly for this population. The aim of this study was to employ the NORGEP-NH Criteria to study the extent of potentially inappropriate medication use among nursing home residents and explore possible associated factors. Due to demographic changes and an intensified effort in community care of the elderly [1], residents in European nursing homes have over the past decades become increasingly frail, often with multiple active diagnoses [2]. Development in the field of pharmacology has given doctors a broader palette in their effort to treat discomfort and diseases. As a result, it is common for nursing home residents to have medication lists of substantial length. A US study from 2004 found polypharmacy, defined as 9 or more medications, in 40% of nursing home residents [5]
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have