Medication Use in Residential Care Facilities for the Elderly

Williams, Bradley R.; Nichol, Michael B.; Lowe, Beverly; Yoon, Peter S; McCombs, Jeffrey S.; Margolies, Jane E

doi:10.1345/aph.17424

Cited by 41 publications

(16 citation statements)

References 32 publications

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“…These results may be the result of a small sample with limited power to detect these relations, and clarification of this issue will require a larger study. The total number of medications per patient found in this study (3.7) is somewhat lower than that found in several other studies (van Dijk et al, 1998;Williams, Nichol, Yoon, McCombs & Margolies, 1999;Golden et al, 1998). For example, Golden et al (1998) found that the average number of medications per person in a large sample of homebound elderly was 5.3, with a standard deviation of 2.9.…”

Section: Discussioncontrasting

confidence: 76%

Factors related to medication adherence in memory disorder clinic patients

Ownby

Hertzog

Crocco

et al. 2006

Aging & Mental Health

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Medication adherence is a substantial problem in the elderly. It may be even more important among elderly persons with memory problems, since other factors that lead to non-adherence may be compounded with the memory problems themselves. The objective was to determine whether a model that integrates research on medication adherence from several research domains is useful in understanding adherence in elderly patients. The methodology involved a cross-sectional observational study using a convenience sample of 63 patients drawn from a university-affiliated outpatient memory disorders clinic. The primary measure of medication adherence was caregivers' reports of patients' medication adherence. Patients and their caregivers were asked questions assessing their beliefs about the seriousness of each condition for which a medication was prescribed and the likely outcome of that condition without treatment. Additional data collected included presence of side effects, total number of medications taken, and patients' mood and cognitive status. Multilevel path analysis confirmed several model-based predictions. Caregivers' reports of adherence were predicted by estimates of disease outcome, the presence of side effects, and patients' relying on themselves to remember to take medications. Results partially confirm the integrative model in understanding medication adherence in these patients. Patients' beliefs about the likely effect of medication treatment for their condition and the presence of side effects influence reported medication adherence. Results thus suggest that efforts to educate patients about the likely response of their medical condition to treatment and to assess and deal with medication side effects might improve patient adherence.

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Section: Discussioncontrasting

confidence: 76%

Factors related to medication adherence in memory disorder clinic patients

Ownby

Hertzog

Crocco

et al. 2006

Aging & Mental Health

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“…They take multiple medicines with an increased risk of adverse drug events [1][2][3][4]. Their dependency and frequent cognitive impairment undermine their capacity to report symptoms.…”

Section: Introductionmentioning

confidence: 99%

Clinical medication review by a pharmacist of elderly people living in care homes—randomised controlled trial

Zermansky¹,

Alldred²,

Petty³

et al. 2006

Age and Ageing

292

320

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Objective: to measure the impact of pharmacist-conducted clinical medication review with elderly care home residents. Design: randomised controlled trial of clinical medication review by a pharmacist against usual care. Setting: sixty-five care homes for the elderly in Leeds, UK. Participants: a total of 661 residents aged 65+ years on one or more medicines. Intervention: clinical medication review by a pharmacist with patient and clinical records. Recommendations to general practitioner for approval and implementation. Control patients received usual general practitioner care. Main outcome measures: primary: number of changes in medication per participant. Secondary: number and cost of repeat medicines per participant; medication review rate; mortality, falls, hospital admissions, general practitioner consultations, Barthel index, Standardised Mini-Mental State Examination (SMMSE). Results: the pharmacist reviewed 315/331 (95.2%) patients in 6 months. A total of 62/330 (18.8%) control patients were reviewed by their general practitioner. The mean number of drug changes per patient were 3.1 for intervention and 2.4 for control group (P < 0.0001). There were respectively 0.8 and 1.3 falls per patient (P < 0.0001). There was no significant difference for GP consultations per patient (means 2.9 and 2.8 in 6 months, P = 0.5), hospitalisations (means 0.2 and 0.3, P = 0.11), deaths (51/331 and 48/330, P = 0.81), Barthel score (9.8 and 9.3, P = 0.06), SMMSE score (13.9 and 13.8, P = 0.62), number and cost of drugs per patient (6.7 and 6.9, P = 0.5) (£42.24 and £42.94 per 28 days). A total of 75.6% (565/747) of pharmacist recommendations were accepted by the general practitioner; and 76.6% (433/565) of accepted recommendations were implemented. Conclusions: general practitioners do not review most care home patients' medication. A clinical pharmacist can review them and make recommendations that are usually accepted. This leads to substantial change in patients' medication regimens without change in drug costs. There is a reduction in the number of falls. There is no significant change in consultations, hospitalisation, mortality, SMMSE or Barthel scores.

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“…Studien in den USA und den nordischen Ländern zeigen einen zum Teil inadäquaten Gebrauch von Arzneimitteln in Altenheimen (10,18,23,30). Ergebnisse liegen hier insbesondere zur Anwendung von Psychopharmaka, Herz-Kreislaufmedikamenten sowie für Medikamente vor, die für Hochbetagte mit besonderen Risiken verbunden sind.…”

Section: Patienten In Altersheimen Sollten Aufgrund Ihrer Gebrechlichunclassified