Abstract
Background People living in nursing homes are highly vulnerable and frail. Polypharmacy and inappropriate prescription (IP) are also common problems. Objectives The objectives of the study are (i) to study the baseline situation and calculate the frailty index (FI) of the residents, (ii) to assess the results of routine clinical practice to do a pharmacotherapy review (patient-centred prescription (PCP) model) (Molist Brunet et al., Eur Geriatr Med. 2015;6:565–9) and (iii) to study the relationship between IP and frailty, functional dependence, advanced dementia and end-of-life situation. Setting Two nursing homes in the same geographical area in Catalonia (Spain). Method This was a prospective, descriptive and observational study of elderly nursing home residents. Each patient’s treatment was analysed by applying the PCP model, which centres therapeutic decisions on the patient’s global assessment and individual therapeutic goal. Main outcome measure Prevalence of polypharmacy and IP. Results 103 patients were included. They were characterized by high multimorbidity and frailty. Up to 59.2% were totally dependent. At least one IP was identified in 92.2% of residents. Prior to the pharmacological review, the mean number of chronic medications prescribed per resident was 6.63 (SD 2.93) and after this review it was 4.97 (SD 2.88). Polypharmacy decreased from 72.55% to 52.94% and excessive polypharmacy fell from 18.62% to 5.88%.The highest prevalence of IP was detected in people with a higher FI, in those identified as end-of-life, and also in more highly dependent residents (p < 0.05). Conclusions People who live in nursing homes have an advanced frailty. Establishing individualized therapeutic objectives with the application of the PCP model enabled to detect 92.2% of IP. People who are frailer, are functionally more dependent and those who are end-of-life are prescribed with inappropriate medication more frequently.
Highlights
People who live in nursing homes share a high vulnerability and frailty [1]
In our study we have proposed measures for pharmacological adjustment in people whose mean systolic blood pressure (SBP) was under 130 mmHg in the last year. (iv) Dyslipidaemia: statins are not recommended for primary prevention in end-of-life patients, regardless of the indication
We included a few more patients than our calculation recommended due to the large differences existing in the literature regarding inappropriate prescription (IP) prevalence. These results enable us to confirm that the application of the PCP model in clinical practice considerably optimizes pharmacological prescription in frail nursing home patients
Summary
People who live in nursing homes share a high vulnerability and frailty [1]. They are usually characterized by high functional dependence. Frailty [3] (common clinical syndrome in elderly that carries an increased risk of poor health outcomes) is identified in almost all nursing home residents, and in most cases, it is moderate or severe [4]. Frail people most often experience falls, immobility and confusion syndromes, as outlined in a review of nursing homes in the UK [4]. In UK nursing homes, a large number of residents are end-of-life. People living in nursing homes are highly vulnerable and frail.
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