Abstract
Background: Multiple studies have assessed the appropriateness of the use of medicines for nursing home residents; however, few have included duration of use in their assessment. The aim of this study was to assess the level and duration of use of medications recommended for short-term use in residents of aged care facilities in Australia. Methods: Australian Government Department of Veterans’ Affairs (DVA) administrative claims data were used for this study. Veterans eligible for all health services subsidised by DVA were followed for one year from 1 July 2015 to 30 June 2016. The number of days covered for each medicine was calculated by multiplying the number of prescriptions dispensed during the year by the pack duration for the medicine. The pack duration was calculated by dividing the quantity supplied at each dispensing by the usual number of doses per day in older people according to Australian prescribing guidelines. The proportion of patients using each medicine and the number of days covered during the study period were determined. Results: 14, 237 residents met the inclusion criteria. One in five participants were dispensed antipsychotics, and the median duration of use was 180 days in the one-year period. More than one-third were dispensed a benzodiazepine, and the median duration of use was 240 days in the year. Half were dispensed an opioid analgesic with a median duration of use of 225 days in the year. Fifty-two percent were dispensed proton pump inhibitors with a median duration of use of 360 days in the year. A quarter received an antibiotic recommended for the management of urinary tract infection, with a median duration of use of 14 days in the year. Conclusion: Long-term use of antipsychotics, benzodiazepines, opioid analgesics and proton pump inhibitors is common in aged care residents. Ensuring appropriate duration of use for these medicines is necessary to reduce risk of harm.
Highlights
Older people frequently have multiple comorbidities, and in turn, they commonly use both shortand long-term medications to manage these conditions [1]
The aim of this study was to assess the duration and prevalence of use of medications recommended for short-term use in residents of aged care facilities in Australia, with a focus on antipsychotics, benzodiazepines, opioid analgesics, antiemetics, non-steroidal anti-inflammatory drugs (NSAIDs), pump inhibitors (PPIs) and antibiotics for urinary tract infections
We reviewed Australian prescribing references, including the Australian Medicines Handbook [18], and potentially inappropriate medicines lists, including the Screening Tool of Older People’s Prescriptions (STOPP)/Screening Tool to Alert to Right Treatment (START) criteria [9] and the Beers criteria [8], to identify medicines which are recommended for short-term use in older people (Table 1)
Summary
Older people frequently have multiple comorbidities, and in turn, they commonly use both shortand long-term medications to manage these conditions [1]. A systematic review which included 44 studies from 22 countries found that up to 91% of long-term facility residents use five or more medicines and 65% take eleven or more medicines concurrently [7]. Multiple studies have assessed the appropriateness of the use of medicines for nursing home residents; few have included duration of use in their assessment. The aim of this study was to assess the level and duration of use of medications recommended for short-term use in residents of aged care facilities in Australia. Fifty-two percent were dispensed proton pump inhibitors with a median duration of use of 360 days in the year. Conclusion: Long-term use of antipsychotics, benzodiazepines, opioid analgesics and proton pump inhibitors is common in aged care residents. Ensuring appropriate duration of use for these medicines is necessary to reduce risk of harm
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