Individualized Medication Review in Older People with Multimorbidity: A Comparative Analysis between Patients Living at Home and in a Nursing Home

Abstract

(1) Background: aging is associated with complex and dynamic changes leading to multimorbidity and, therefore, polypharmacy. A periodic medication review (MR) in frail older people leads to optimizing medication use. The aims of the study were to perform a comparative analysis of the impact of place of residence (own home versus nursing home) in a cohort of older patients on the characteristics of the baseline therapeutic plan and characteristics of the therapeutic plan after an MR; (2) Methods: Study with paired pre- and post-MR data based on person-centred prescription, with a follow-up assessment at three months. Patients who lived either in their own home or in a nursing home were recruited. We selected patients of 65 years or more with multimorbidity whose General Practitioner identified difficulties with the prescription management and the need for an MR. Each patient’s treatment was analysed by applying the Patient-Centred Prescription (PCP) model; (3) Results: 428 patients. 90% presented at least one inappropriate prescription (IP) in both settings. In nursing homes, a higher number of implemented optimization proposals was detected (81.6% versus 65.7% (p < 0.001)). After the MR, nursing-home patients had a greater decrease in their mean number of medications, polypharmacy prevalence, therapeutic complexity, and monthly drug expenditure (p < 0.001); (4) Conclusions: PCP model detected a high number of IP in both settings. However, after an individualized MR, nursing-home patients presented a greater decrease in some pharmacological parameters related to adverse events, such as polypharmacy and therapeutic complexity, compared to those living at home. Nursing homes may be regarded as a highly suitable scenario to carry out a periodic MR, due to its high prevalence of frail people and its feasibility to apply the recommendations of an MR. Prospective studies with a robust design should be performed to demonstrate this quasi-experimental study along with a longitudinal follow-up on clinical outcomes.

Caring for Frail Older People Living Alone in Italy: Future Housing Solutions and Responsibilities of Family and Public Services, a Qualitative Study

“…This is also reported in the previous literature, with the specification that seniors living at home are more likely to have hospital admissions than those in institutions [ 90 ], and that a quarter of admissions of older people in residential facilities seems associated with their inability to self-administer drugs [ 91 ]. Moreover, in another study [ 92 ], senior residents showed a decreasing prevalence in both polypharmacy and complex therapies, with regard to those ageing at home. Our respondents also referred to the acceptance of moving to a nursing home to relieve family members of the burden of caring.…”

Improving individualized prescription in patients with multimorbidity through medication review

“…The study has a quasi-experimental design (pre-post study) including a cohort of patients with multimorbidity (Community Older Patients cohort (COP cohort)) [ 16 , 23 ], in the Osona County, a mixed urban–rural district from Catalonia (Spain), with a three-month follow-up. Data were collected from June 2019 to October 2020.…”

“…An MR was carried out. Based on the current evidence, different criteria were used to determine inappropriate prescriptions in the most prevalent chronic conditions [ 23 ]: type 2 Diabetes Mellitus (T2DM) (guidelines of the American Diabetes Association (ADA) were applied [ 38 , 39 ]); hypertension and cardiovascular therapy [ 40 ]; dyslipidemia [ 41 ]; mental health and dementia (the recommendations of the European Association of Palliative Care were followed [ 42 ] and, the progressive dose decrease of chronic antipsychotic treatment was proposed in individuals who had not suffered behavioral disorders in the last 3–6 months [ 40 , 43 ]); and chronic pain (following Beers and STOPP criteria [ 44 – 46 ]). The STOPPFrail criteria were applied in patients identified at the end of life (according to NECPAL CCOMS-ICO© [ 34 ]) [ 40 ].…”

Frailty modifies the effect of polypharmacy and multimorbidity on the risk of death among nursing home residents: Results from the SHELTER study

“…However, evidence is still conflicting on whether desprescribing will have any effect on mortality as well as several factors are involved into the deprescribing process ( 34 ). A STOPPFrail-guided deprescribing plan in older nursing home residents with frailty and polypharmacy was successful in reducing polypharmacy but did not affect mortality, although the study may not have been sufficiently powered to assess this ( 35 ). As our study found higher mortality associated with hyperpolypharmacy in non-frail individuals, the question is whether deprescribing should be prioritized in individual's without frailty.…”