Drug prescriptions in nursing home residents: an Italian multicenter observational study

Pasina, Luca; Novella, Alessio; Cortesi, Laura; Nobili, Alessandro; Tettamanti, Mauro; Ianes, Aladar

doi:10.1007/s00228-020-02871-7

Cited by 28 publications

(32 citation statements)

References 40 publications

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“…In fact, these are the most ubiquitous compounds detected in wastewaters from senior residences. Our empirical data coincides with previous studies indicating that antipsychotics, laxatives, benzodiazepines and antiplatelets among others are highly consumed by the elderly [ 11 , 19 ] and have been detected in river waters with quite high frequency [ 8 , 17 , 18 , 20 ].…”

Section: Resultssupporting

confidence: 91%

“…This age-group consumes a higher quantity of pharmaceuticals than the rest of the population, with an estimated intake 5 to 10 pills inhab −1 day −1 [ 10 ]. The most consumed pharmaceuticals are within the category of nervous system (N, according to the Anatomic Therapeutic Code, ATC), alimentary tract (A), anti-infective (J) and antineoplastic for the treatment of cancer (L) and the doses administered increase compared to the younger population [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

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Pharmaceutical Residues in Senior Residences Wastewaters: High Loads, Emerging Risks

2021

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Senior residences are health-care facilities that are socially-accepted for the assistance of elderly people. Since the elderly account for the foremost pharmaceutical-consuming age-group, senior residences become a hot-spot for pharmaceuticals discharge to the sewage grid. The objectives of the present study were to identify the bioactive pharmaceuticals in sewage waters from senior residences and to propose an on-site monitoring strategy for their control. In this study, we have studied the presence of 43 pharmaceuticals highly consumed by the elderly population in six senior residences located in Spain, France and Portugal. Wastewater was sampled directly from the water-chest in each residence during different times of the day throughout one week. Main compounds detected at the high µg L−1 level were analgesic and antipyretic drugs such as acetylsalicylic acid, paracetamol, ibuprofen; antibiotics such as amoxicillin and sulfamethoxazole; compounds for the treatment of neuropathies as gabapentin, trazodone and valsartan; pharmaceuticals for the treatment of diabetes (vildagliptin) and anticancer drugs. The daily loads discharged were estimated and their fate was evaluated. The final objective of this study is to highlight the need to implement at-source waste water treatment procedures in senior residences, which have been identified as a point source pollution of pharmaceuticals.

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Section: Resultssupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Pharmaceutical Residues in Senior Residences Wastewaters: High Loads, Emerging Risks

2021

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“…There is strong evidence that suggests, however, that antipsychotics have modest efficacy and are associated with cerebrovascular events and death [7][8][9]. Despite a relatively high use of benzodiazepines [10][11][12][13], evidence supporting clinical efficacy is very limited [14][15][16] and may be associated with a higher risk of falls, cognitive impairment, and sedation [17,18]. Guidelines advise against a range of antidepressants, especially those with anticholinergic effects, because of side effects and adverse effects [19].…”

Section: Introductionmentioning

confidence: 99%

What Makes Deprescription of Psychotropic Drugs in Nursing Home Residents with Dementia so Challenging? A Qualitative Systematic Review of Barriers and Facilitators

et al. 2021

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Background Behavioral and psychological symptoms of dementia are frequently experienced in the nursing home setting and place a substantial burden on patients, relatives, and nursing home staff. Despite guidelines recommending non-pharmacological treatments, psychotropic drugs are often prescribed to address these symptoms. This is the case despite their effects being limited, and there being a risk of side effects and adverse events for the patient. Several studies have aimed to reduce the use of psychotropic drugs, with varying results. The reasons behind these variations are not well understood. Objectives The objective of this systematic review was to investigate which factors nursing home general practitioners and nursing home staff experience as barriers or facilitators when attempting to deprescribe psychotropic drugs in nursing home residents. Methods We searched PubMed, EMBASE, psycINFO, Web of Science, and CINAHL between April and September 2020. An inductive method using thematic analysis of the qualitative findings was applied for the derivation of themes. Quantitative studies were included but described descriptively and separately. Results Of 8204 unique records, 14 studies were included in the review. Of these, nine were interview or focus group studies and five were survey studies. Thematic analysis resulted in five major themes identified as either facilitators or barriers or both: (1) 'Operationality and routines'; (2) 'Lack of resources and qualifications'; (3) 'Patient-related outcomes', which points to a strong belief in negative patient-related outcomes of discontinuation and a downplay of side effects of the medication; (4) 'Policies', including support and buy-in from nursing home leadership; and (5) 'Collaboration' between physicians and nursing home staff. Themes 1 and 4 consist of facilitators. Theme 2 consists of barriers. Theme 3 and 5 consist of both facilitators and barriers. Evaluation of closed-ended questions from the surveys supported the findings. Conclusions Deprescribing psychotropic drugs used for behavioral and psychological symptoms of dementia in nursing home residents is challenging. Resources need to be in place for deprescribing, as well as there being a focus on the positive patient-related outcomes of doing so. Managerial support, staff routines, and interprofessional collaboration are some factors facilitating the process, in addition to there being routines and systematic procedures in place allowing for operationality and a common understanding. Addressing these barriers and facilitators is necessary to ensure that deprescribing can be understood as meaningful and pursued among healthcare professionals in the nursing home setting.

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“…Drugs for cardiovascular diseases, psychotropic drugs, laxatives and analgesics are the most frequently and chronically used medicines, and antiplatelets, mostly acetylsalicylic acid (ASA), are among the most prescribed cardiovascular drugs in NH residents. [6][7][8][9] However, the benefits of antiplatelets to prevent cardio-and cerebrovascular disease are recognized and appropriate only for "secondary prevention" (e.g. for patients who have had a recent heart attack or stroke).…”

Section: Introductionmentioning

confidence: 99%

“…NH residents are complex, vulnerable patients 1 often with a higher burden of cognitive deficits than non‐institutionalized elderly are. Drugs for cardiovascular diseases, psychotropic drugs, laxatives and analgesics are the most frequently and chronically used medicines, and antiplatelets, mostly acetylsalicylic acid (ASA), are among the most prescribed cardiovascular drugs in NH residents 6–9 …”

Section: Introductionmentioning

confidence: 99%

Inappropriate use of antiplatelet agents for primary prevention in nursing homes: An Italian multicenter observational study

Pasina

Novella

Elli

et al. 2020

Geriatrics Gerontology Int

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Aim The benefits of antiplatelets to prevent cardio‐ and cerebrovascular disease are recognized and appropriate only for “secondary prevention.” This multicenter retrospective study was designed to (i) examine the prevalence of residents receiving antiplatelets for primary and secondary cardio‐ and cerebrovascular prevention, and (ii) evaluate the predictors of inappropriate antiplatelet prescription. Methods This study was conducted in a sample of Italian long‐term care nursing homes (NHs). Appropriate use of antiplatelets was defined in accordance with the strongest evidence‐based indications. Results Among the 2579 patients recruited from 27 long‐term care NHs (age mean ± SD: 86.8 ± 7.3; women: 1995; 77.4%), 1092 were treated with antiplatelets (42.3%) and 619 (56.7%) were receiving antiplatelet agents for inappropriate primary prevention of cardio‐ or cerebrovascular atherothrombotic events. Age, dementia or cerebral atherosclerosis, congestive heart failure, peripheral vascular disease, diabetes without chronic complication and hypertension were predictors of inappropriate prescription of antiplatelets. Patients inappropriately treated with antiplatelets also had a higher risk of receiving proton pump inhibitors than those appropriately not treated in univariate (OR 95% CI = 2.79 (2.25–3.46, p < 0.0001) and multivariate models (OR 95% CI 2.71 (2.16–3.40, p < 0.0001). Conclusions Most patients receiving antiplatelet agents in NHs are being inappropriately treated for primary prevention of cardio‐ or cerebrovascular disease. NH residents with diagnosis of dementia or cerebral atherosclerosis, congestive heart failure, peripheral vascular disease, diabetes without chronic complication and hypertension seemed more likely to receive antiplatelets inappropriately. Patients without an evidence‐based indication for antiplatelets also received proton‐pump inhibitors in an unnecessary “prescribing cascade,” which should be assessed for de‐prescribing. Geriatr Gerontol Int 2020; 20: 828–832.

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Drug prescriptions in nursing home residents: an Italian multicenter observational study

Cited by 28 publications

References 40 publications

Pharmaceutical Residues in Senior Residences Wastewaters: High Loads, Emerging Risks

Pharmaceutical Residues in Senior Residences Wastewaters: High Loads, Emerging Risks

What Makes Deprescription of Psychotropic Drugs in Nursing Home Residents with Dementia so Challenging? A Qualitative Systematic Review of Barriers and Facilitators

Inappropriate use of antiplatelet agents for primary prevention in nursing homes: An Italian multicenter observational study

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