Abstract
BackgroundTo investigate the use of potentially inappropriate medications and their relation to the length of nursing home stay among older adults.MethodsQuestionnaire surveys using the Multi-Dimensional Dementia Assessment scale were sent out to all nursing homes in Västerbotten county in northern Sweden in 2007 and 2013. In total, 3186 adults (1881 from 2007 and 1305 from 2013) ≥65 years old were included and 71.8% of those had cognitive impairment. Potentially inappropriate medications were identified using drug-specific quality indicators according to Swedish National Board of Health and Welfare.ResultsPotentially inappropriate medications were used by 48.0% of the 2007 study sample and by 28.4% of the 2013 study sample. The prevalence of glibenclamide use 2007 and antipsychotic drug use 2013 increased linearly (β = 0.534E− 3, 95% CI: 0.040E− 3-0.103E− 2, p = 0.034 and β = 0.155E− 2, 95% CI: 0.229E− 3-0.288E− 2, p = 0.022, respectively) with the length of nursing home stay. No significant association was found between the prevalence of propiomazine, codeine, long-acting benzodiazepines, anticholinergics, NSAIDs, tramadol or the total use of potentially inappropriate medications and the length of stay in nursing homes in 2007 or 2013. Antipsychotics were the most commonly prescribed of the drug classes investigated and used by 22.6% of the residents 2007 and by 16.0% of the residents 2013.ConclusionsThese results indicate that treatment with potentially inappropriate medications is common among older adults living in nursing homes, but it seems to be related to the length of nursing home stay only to a smaller extent. Drug treatment should regularly be reviewed and followed-up among nursing home residents regardless of their length of nursing home stay, in order to prevent unnecessary adverse events.
Highlights
To investigate the use of potentially inappropriate medications and their relation to the length of nursing home stay among older adults
By using explicit quality indicators to identify potentially inappropriate medications (PIMs) use among the residents, we found out that the prevalence of older adults using glibenclamide in 2007 and the prevalence of older adults using antipsychotic drugs in 2013 increased linearly (β = 0.534E− 3, 95% confidence interval (CI): 0.040E− 3-0.103E− 2, p = 0.034 and β = 0.155E− 2, 95% CI: 0.229E− 3-0.288E− 2, p = 0.022, respectively) as the length of stay in nursing homes increased (Fig. 1.6a and 1.8b) when adjusted for age, sex, level of cognitive function, activities of daily living (ADL) and number of medications
No significant association was found between the prevalence of residents using long-acting benzodiazepines, anticholinergic drugs, tramadol, propiomazine, codeine, Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) or the total use of PIMs and the length of stay in nursing homes for neither study population (Fig. 1.1-5, 1.7 and 1.9)
Summary
To investigate the use of potentially inappropriate medications and their relation to the length of nursing home stay among older adults. Older adults living in nursing homes have more comorbidities compared to their counterparts in the wider community [1] and major neurocognitive disorders are Sönnerstam et al BMC Geriatrics (2022) 22:70. Older adults in nursing homes and especially those with major neurocognitive disorders, are vulnerable to drugs and more prone to experience adverse drug reactions and hospital admissions [1, 3, 5]. Nursing home residents are often subject to polypharmacy and are prescribed more potentially inappropriate medications (PIMs) such as psychotropic drugs, compared to community-dwelling older adults [1, 9,10,11]. Antipsychotics are utilized to treat agitation, aggression, delusions and hallucinations [13], i.e. behavioural disturbances associated with major neurocognitive disorders that nursing home residents often experience [4]. Other PIMs that are often prescribed are anticholinergic drugs which contribute to cognitive impairment and delirium [18]
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