Polypharmacy in Nursing Homes

Roh, Elaine; Cota, Esteban; Lee, Jason P.; Madievsky, Ruth; Eskildsen, Manuel

doi:10.1016/j.cger.2022.05.007

Cited by 2 publications

(1 citation statement)

References 32 publications

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“…Although multiple medications may sometimes be indicated in severely ill patients, the widespread prevalence of polypharmacy in older adult populations has been well documented, especially in long-term care facilities [ 108 ]. However, polypharmacy among older adults in the general population is also common, as demonstrated in a recent study that included 2.12 billion outpatient visits in adults aged ≥ 65 years [ 109 ].…”

Section: High-risk Populationsmentioning

confidence: 99%

An Evidence-Based Update on Anticholinergic Use for Drug-Induced Movement Disorders

Vanegas-Arroyave,

Caroff,

Citrome

et al. 2024

CNS Drugs

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Drug-induced movement disorders (DIMDs) are associated with use of dopamine receptor blocking agents (DRBAs), including antipsychotics. The most common forms are drug-induced parkinsonism (DIP), dystonia, akathisia, and tardive dyskinesia (TD). Although rare, neuroleptic malignant syndrome (NMS) is a potentially life-threatening consequence of DRBA exposure. Recommendations for anticholinergic use in patients with DIMDs were developed on the basis of a roundtable discussion with healthcare professionals with extensive expertise in DIMD management, along with a comprehensive literature review. The roundtable agreed that “extrapyramidal symptoms” is a non-specific term that encompasses a range of abnormal movements. As such, it contributes to a misconception that all DIMDs can be treated in the same way, potentially leading to the misuse and overprescribing of anticholinergics. DIMDs are neurobiologically and clinically distinct, with different treatment paradigms and varying levels of evidence for anticholinergic use. Whereas evidence indicates anticholinergics can be effective for DIP and dystonia, they are not recommended for TD, akathisia, or NMS; nor are they supported for preventing DIMDs except in individuals at high risk for acute dystonia. Anticholinergics may induce serious peripheral adverse effects (e.g., urinary retention) and central effects (e.g., impaired cognition), all of which can be highly concerning especially in older adults. Appropriate use of anticholinergics therefore requires careful consideration of the evidence for efficacy (e.g., supportive for DIP but not TD) and the risks for serious adverse events. If used, anticholinergic medications should be prescribed at the lowest effective dose and for limited periods of time. When discontinued, they should be tapered gradually. Graphical Abstract

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Section: High-risk Populationsmentioning

confidence: 99%

An Evidence-Based Update on Anticholinergic Use for Drug-Induced Movement Disorders

Vanegas-Arroyave,

Caroff,

Citrome

et al. 2024

CNS Drugs

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Medication Management in Portuguese Long-Term Care Facilities: A Preliminary Cross-Sectional Study

Rodrigues,

Mascarenhas-Melo,

Bell

2024

Healthcare

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Background/Objectives: Population ageing has been a pressing global issue for decades. Older adults, especially those residing in long-term care facilities (LTCFs), often experience frailty and polypharmacy, which can lead to negative clinical outcomes. In Portugal, LTCFs provide essential care for individuals aged 65 or older, offering temporary or permanent accommodation. These facilities are not considered healthcare providers, and as a result, pharmaceutical services are not mandatory. This study aimed to evaluate medication management practices in Portuguese LTCFs, identify which professionals are responsible for managing medications, and identify potential gaps in safety and efficacy. Methods: A cross-sectional electronic questionnaire was sent by email to 2552 Portuguese LTCFs from the Portuguese “Carta Social” database. Data collection took place between 20 July and 2 August 2023, yielding a response rate of 15.4% (392 institutions). Results: Most LTCFs (94.39%) oversee their resident’s medication, with 75.95% using the same pharmacy. Individualised medication packaging is used by 57.84% of facilities, and 97.84% provide medication reconciliation and review, mainly conducted by physicians and nurses. Medication is often stored in nursing offices (81.12%) but also in kitchens or dining rooms. Nurses are responsible for medication storage (87.50%) and preparation (81.89%), although non-nursing staff are also involved. In 63.27% of LTCFs, the same individual is responsible for both the preparation and verification of medication. Assistants are involved in both the checking (30.56%) and administering (45.66%) of medication. Conclusions: The results presented illustrate the current status of LTCFs in Portugal. Medication management presents a significant challenge, and it is notable that the role of the pharmacist in this process is not as prominent as it is in other countries.

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Polypharmacy in Nursing Homes

Cited by 2 publications

References 32 publications

An Evidence-Based Update on Anticholinergic Use for Drug-Induced Movement Disorders

An Evidence-Based Update on Anticholinergic Use for Drug-Induced Movement Disorders

Medication Management in Portuguese Long-Term Care Facilities: A Preliminary Cross-Sectional Study

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