Outcomes of Polypharmacy in Nursing Home Residents
Section snippets
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.
References (91)
- et al.
Physician intervention for medication reduction in a nursing home: the polypharmacy outcomes project
J Am Med Dir Assoc
(2011) - et al.
A new method of classifying prognostic comorbidity in longitudinal studies: development and validation
J Chronic Dis
(1987) - et al.
Polypharmacy as a risk factor for adverse drug reactions in geriatric nursing home residents
Am J Geriatr Pharmacother
(2006) - et al.
Analysis of drug–drug interactions (DDIs) in nursing homes in Central Taiwan
Arch Gerontol Geriatr
(2008) - et al.
Falls in the nursing home: Are they preventable?
J Am Med Dir Assoc
(2005) - et al.
Incident use and outcomes associated with potentially inappropriate medication use in older adults
Am J Geriatr Pharmacother
(2010) - et al.
Utilization of emergency room and hospitalization by Chinese nursing home residents: a cross-sectional study
J Am Med Dir Assoc
(2010) - et al.
Self-rated health and mortality in Chinese institutional elderly persons
J Clin Epidemiol
(1997) - et al.
Drug costs and use in VHA nursing homes: a national overview of long-stay residents
J Am Med Dir Assoc
(2007) - et al.
A pharmacy management intervention for optimizing drug therapy for nursing home patients
Am J Geriatr Pharmacother
(2004)
Inappropriate drug prescribing and related outcomes for elderly Medicaid beneficiaries residing in nursing homes
Clin Ther
Drug-related morbidity and mortality: updating the cost-of-illness model
J Am Pharm Assoc (Wash)
Nursing home medication administration cost minimization analysis
J Am Med Dir Assoc
Analysis of the North Carolina long-term care polypharmacy initiative: a multiple-cohort approach using propensity-score matching for both evaluation and targeting
Clin Ther
Does the addition of a pharmacist transition coordinator improve evidence-based medication management and health outcomes in older adults moving from the hospital to a long-term care facility?Results of a randomized, controlled trial
Am J Geriatr Pharmacother
Potentially inappropriate medication prescriptions among elderly nursing home residents: their scope and associated resident and facility characteristics
Health Serv Res
Inappropriate prescribing in the older population: need for new criteria
Age Ageing
Inappropriate prescribing in the elderly
J Clin Pharm Ther
Recent advances in geriatrics: drug-related problems in the elderly
Ann Pharmacother
Potentially inappropriate drug prescriptions and risk of hospitalization among older, Italian, nursing home residents: the ULISSE project
Drugs Aging
Use of potentially inappropriate drugs in nursing homes
Pharmacotherapy
Explicit criteria for determining potentially inappropriate medication use by the elderlyAn update
Arch Intern Med
Inappropriate use of nonpsychotropic medications in nursing homes
J Am Geriatr Soc
Explicit criteria for determining inappropriate medication use in nursing home residentsUCLA Division of Geriatric Medicine
Arch Intern Med
Potentially inappropriate prescriptions for older patients in long-term care
BMC Geriatr
Inappropriate medication prescribing in skilled-nursing facilities
Ann Intern Med
Defining inappropriate practices in prescribing for elderly people: a national consensus panel
CMAJ
Inappropriate prescribing in older residents of Australian care homes
J Clin Pharm Ther
Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts
Arch Intern Med
Exposure to potentially inappropriate drugs and drug–drug interactions in elderly nursing home residents in Helsinki, Finland: a cross-sectional study
Drugs Aging
Prevalence of inappropriate medication using Beers criteria in Japanese long-term care facilities
BMC Geriatr
Adverse outcomes associated with inappropriate drug use in nursing homes
Ann Pharmacother
Nursing-home residents and their drug use: a comparison between mentally intact and mentally impaired residentsThe Bergen district nursing home (BEDNURS) study
Eur J Clin Pharmacol
Polypharmacy and inappropriate medication use in Singapore nursing homes
Ann Acad Med Singapore
Drug-related problems: their structure and function
DICP
Predictors of medication prescription in nursing homes
J Am Med Dir Assoc
Improving prescribing in the elderly: a study in the long term care setting
Can J Clin Pharmacol
Development and validation of an improving prescribing in the elderly tool
Can J Clin Pharmacol
Audits of medication use in Sydney nursing homes
Age Ageing
Potentially inappropriate medications in nursing homes: sources and correlates
Internet Journal of Geriatrics and Gerontology
Suboptimal prescribing in older inpatients and outpatients
J Am Geriatr Soc
Adverse drug events in high risk older outpatients
J Am Geriatr Soc
Identifying adverse drug events: development of a computer-based monitor and comparison with chart review and stimulated voluntary report
J Am Med Inform Assoc
Risk factors for adverse drug events among nursing home residents
Arch Intern Med
The epidemiology of adverse and unexpected events in the long-term care setting
J Am Geriatr Soc
Cited by (73)
Polifarmacia en personas mayores institucionalizadas
2024, FMC Formacion Medica Continuada en Atencion PrimariaPolypharmacy in Nursing Homes
2022, Clinics in Geriatric MedicineCitation Excerpt :When appropriate, medications are prescribed based on best evidence with the goal of improving quality of life and longevity while reducing harm. When inappropriate or problematic, medications are prescribed not based on evidence and risks outweigh the benefits.2,3 The concern in polypharmacy is derived from its possible complications, which will be further discussed in this article.
Association between polypharmacy and mortality in the older adults: A systematic review and meta-analysis
2022, Archives of Gerontology and GeriatricsCitation Excerpt :Although polypharmacy is expected to have a positive impact on morbidity, there is growing evidence that polypharmacy is generally associated with a higher risk of adverse events, such as poor medication adherence, drug interactions, adverse drug reactions, falls, hospitalizations, and death (Fried et al., 2014; Vetrano et al., 2014). In fact, some previous studies have shown that polypharmacy is associated with increased mortality in older adults, but these findings have been inconsistent and contradictory (C. Franchi et al., 2013; K. Richardson, Ananou, Lafortune, Brayne, & Matthews, 2011; Tamura, Bell, Inaba, & Masaki, 2012). The purpose of this study was to systematically review and meta-analyze all published cohort studies examining the association between polypharmacy and mortality in older people over 65 years of age.
Selected safety-relevant medication processes in Swiss nursing homes: Current state of affairs and optimization potentials
2019, Zeitschrift fur Evidenz, Fortbildung und Qualitat im GesundheitswesenDeprescribing in Nursing Home Residents on Polypharmacy: Incidence and Associated Factors
2019, Journal of the American Medical Directors Association