Drug-Related Problems and Polypharmacy in Nursing Home Residents: A Cross-Sectional Study

Abstract

At present, 19.2% of the Spanish population is aged 65 or older. Polypharmacy is a frequent condition among the elderly, especially in those living in nursing homes, which is associated with adverse outcomes, such as adverse drug events or drug-drug interactions. This study aimed to assess the pattern of polypharmacy in a nursing home in Leon, one of Spain’s most ageing regions, and its relationship with different drug-related problems. A descriptive, observational, and cross-sectional study design was used; 222 residents were involved in this study. Data on drug use were collected from medical charts. Information was screened with the software CheckTheMeds, BOT PLUS and Drug-Reax. Residents were on a median of 7 medicines. Polypharmacy and inappropriate medications were present in 78.8% and 96.8% of residents, respectively. Drug-related problems were present in almost all the populations evaluated. Drug-drug interactions were very common in participants (81.1%), being severe/moderate in 24.7%. A high prevalence of polypharmacy and drug-related problems in the nursing home population assessed has been observed. A significantly higher risk of suffering drug-drug interactions was revealed for increasing polypharmacy and anticholinergic risk. A regular evaluation of drug prescribing in nursing home residents is necessary to minimize drug-related problems risk.

Potentially Inappropriate Medication and Polypharmacy in Nursing Home Residents: A Cross-Sectional Study

“…Benzodiazepines are commonly prescribed in the elderly for anxiety and insomnia in spite of being one of the pharmacological groups usually implicated in the occurrence of potential DDIs and adverse reactions (sedation, falls and fractures, mental confusion, cognitive decline, etc.) and in the prescription of unnecessary drugs [26,[50][51][52]. If the Beers criteria were applied, benzodiazepines were also involved in 21.6% of PIMs, a value very close to that obtained with the STOPP criteria without the A1 criterion.…”

“…We also found that 37.2% were related to interactions detected in different sections of the Beers criteria: potentially clinically important DDIs to be avoided in older adults (23.3%) and PIM use in older adults due to drug-disease or drug-syndrome interactions that may exacerbate the disease or syndrome (13.9%). In the case of potentially clinically important DDIs, 87.5% were due to the use of three or more CNS-active drugs, and in most of them (83.1%), combinations including benzodiazepines and nonbenzodiazepines, benzodiazepine receptor agonist hypnotics, or opioids were included, with a remarkably increased risk of falls and other disorders such as central nervous system depression and dementia [26,50,59,60]. A high consumption of benzodiazepines has been reported among NH residents, who also showed an increased risk of mental health disorders [61].…”

“…According to previous studies, polypharmacy status was categorised into 3 groups: non-polypharmacy (0-4 medicines), polypharmacy (5-9 medicines), and excessive polypharmacy (≥10 medicines) [22][23][24][25][26]. The 2019 Beers criteria, the PRISCUS list, and v2 STOPP criteria were used to classify medications as PIM, and the v2 START criteria were used for PPO.…”

Effect of changes in metabolic enzymes and transporters on drug metabolism in the context of liver disease: Impact on pharmacokinetics and drug–drug interactions

“…168 Also, progressive aging of the population is accompanied with multimorbidity and attendant multiple drug use can be problematic, especially if patients visit several specialists while the information on prescriptions is not exchanged. 149,150,[153][154][155] In addition, patients should also be aware of the importance of this topic and inform their general practitioner about their current use of different medications. Patient information campaigns, organized by health authorities, can increase patient awareness significantly.…”

“…151,152 In western countries, the increase in age of the population and the wider use of drugs for chronic diseases has increased the possibilities of liver-related drug-drug interactions. 149,150,[153][154][155] As described in the preceding sections, the levels of numerous metabolic enzymes and transporters are affected in liver disease. For example, it is well known that CYP3A4 levels are decreased in patients with liver cirrhosis, 136 and also in patients with diabetes and MASLD.…”