Outcomes of Polypharmacy in Nursing Home Residents

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Methods

We conducted a MEDLINE search using such words as polypharmacy, medication, nursing home, long-term care, adverse effects, mortality, death, hospitalization, fracture, falls, and cost. We reviewed only English-language articles starting from 1990. We included primarily original articles specific to nursing homes, and excluded nursing home articles that included home-bound patients, outpatients, assisted living, or hospital settings. There are many definitions of polypharmacy in the literature,

Potentially Inappropriate Drugs

Potentially inappropriate drugs can be defined as those in which the risk of adverse events from the drug outweighs the clinical benefits, and in particular, where there is a safer and more effective alternative (Table 1).3 Potentially inappropriate drugs are a major determinant of adverse drug events (ADEs)4 and have been associated with an increased risk of hospitalization or death.1, 5, 6 There have been many studies demonstrating that polypharmacy was associated with increased likelihood of

Summary

This article provides a comprehensive review of the outcomes of polypharmacy in nursing homes. Our review had some limitations. First, we only included studies beginning in 1990, and significant earlier studies are not included. Only English-language articles were included. We only researched studies from MEDLINE, and may have missed studies based on our search terms and search tools. There are many definitions of polypharmacy in the literature, including number of medications or inappropriate

Disclosures

This research was supported by The John A. Hartford Foundation Center of Excellence in Geriatrics, University of Hawaii; the funding sources had no role in the analysis and preparation of this paper. Dr Bell received compensation for participation in Aloha Care, a local insurance company Pharmacy and Therapeutics committee. Drs Tamura, Inaba and Masaki have no conflicts to declare.

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