Prevalence and Variability in Medications Contributing to Polypharmacy in Long-Term Care Facilities

Jokanovic, Natali; Jamsen, Kris; Tan, Edwin C.K.; Dooley, Michael; Kirkpatrick, Carl M.; Bell, John

doi:10.1007/s40801-017-0121-x

Cited by 15 publications

(23 citation statements)

References 44 publications

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“…Our study findings are consistent with other research in RACSs suggesting that PPI use is highly prevalent [6–8]. Furthermore, our finding that residents taking high-dose PPIs had high levels of polypharmacy and medication regimen complexity compared to low/standard-dose users is consistent with previous RACS research that found PPIs were taken by 72% of residents receiving nine or more regular medications compared to 36% receiving fewer than nine medications [26]. Previous research has predominantly investigated prevalence of PPI use in RACSs using defined daily doses or without assessing dose.…”

Section: Discussionsupporting

confidence: 92%

Patterns of High-Dose and Long-Term Proton Pump Inhibitor Use: A Cross-Sectional Study in Six South Australian Residential Aged Care Services

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Korhonen

et al. 2019

Drugs - Real World Outcomes

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Aim While proton pump inhibitors (PPIs) are generally considered safe and well tolerated, frail older people who take PPIs long term may be susceptible to adverse events. This study characterized PPI use and determined factors associated with high-dose use among older adults in residential aged care services (RACSs). Methods A cross-sectional study of 383 residents of six South Australian RACSs within the same organization was conducted. Clinical, diagnostic, and medication data were collected by study nurses. The proportions of residents who took a PPI for > 8 weeks and without documented indications were calculated. Factors associated with high-dose PPI use compared to standard/low doses were identified using age-and sex-adjusted logistic regression models. Results 196 (51%) residents received a PPI, with 45 (23%) prescribed a high dose. Overall, 173 (88%) PPI users had documented clinical indications or received medications that can increase bleeding risk. Three-quarters of PPI users with gastroesophageal reflux disease or dyspepsia had received a PPI for > 8 weeks. High-dose PPI use was associated with increasing medication regimen complexity [odds ratio (OR) 1.02; 95% confidence interval (CI) 1.01-1.04 per one-point increase in Medication Regimen Complexity Index score] and a greater number of medications prescribed for regular use (OR 1.11; 95% CI 1.01-1.21 per additional medication). Conclusions Half of all residents received a PPI, of whom the majority had documented clinical indications or received medications that may increase bleeding risk. There remains an opportunity to review the continuing need for treatment and consider "step-down" approaches for high-dose PPI users.

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Section: Discussionsupporting

confidence: 92%

Patterns of High-Dose and Long-Term Proton Pump Inhibitor Use: A Cross-Sectional Study in Six South Australian Residential Aged Care Services

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Korhonen

et al. 2019

Drugs - Real World Outcomes

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“…Direct-acting oral anticoagulants were not identified in this study; however, future studies should investigate the impact of these medications on the prescribing of warfarin and other anticoagulants. Although statin use in NHs increased over time points, its use remains low in comparison with recent findings internationally in Australian [8,41], Canadian [42] and European [3] NHs, which found a prevalence of up to 40%. A review of randomized controlled trials (RCTs) and retrospective studies of statin use for secondary prevention in community-dwelling older people identified overall benefit in reduction of cardiovascular events and mortality in those aged ≥ 65 to < 75 years but minimal justification for its use in those aged > 85 years [43].…”

Section: Discussioncontrasting

confidence: 58%

“…Between 13 and 74% of residents in LTCFs take nine or more regular medications [7]. Half of residents are prescribed antithrombotics and up to 80% are prescribed at least one cardiovascular agent [7][8][9]. Compared with older people in the community, residents of LTCFs are less likely to be prescribed medications for stroke (aspirin and other anticoagulants) and for heart disease [β-blockers, angiotensinconverting enzyme inhibitors (ACEIs) and aspirin] [10,11].…”

Section: Key Pointsmentioning

confidence: 99%

Change in Prescribing for Secondary Prevention of Stroke and Coronary Heart Disease in Finnish Nursing Homes and Assisted Living Facilities

et al. 2019

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Background One quarter of residents in long-term care facilities (LTCFs) have a diagnosis of CHD or stroke and over half use at least one preventative cardiovascular medication. There have been no studies that have investigated the longitudinal change in secondary preventative cardiovascular medication use in residents in LTCFs over time.Objective The aim of this study was to investigate the change in cardiovascular medication use among residents with coronary heart disease (CHD) and prior stroke in nursing homes (NHs) and assisted living facilities (ALFs) in Finland over time, and whether this change differs according to dementia status. Methods Three comparable cross-sectional audits of cardiovascular medication use among residents aged 65 years and over with CHD or prior stroke in NHs in 2003 and 2011 and ALFs in 2007 and 2011 were compared. Logistic regression analyses adjusted for gender, age, mobility, cancer and length of stay were performed to examine the effect of study year, dementia and their interaction on medication use. Results Cardiovascular medication use among residents with CHD (NHs: 89% vs 70%; ALFs: 89% vs 84%) and antithrombotic medication use among residents with stroke (NHs: 72% vs 63%; ALFs: 78% vs 69%) declined between 2003 in NHs and 2007 in ALFs. Decline in the use of diuretics, nitrates and digoxin were found in both groups and settings. Cardiovascular medication use among residents with CHD and dementia declined in NHs (88% [95% CI 85-91] in 2003 vs 70% [95% CI 64-75] in 2011) whereas there was no change among people without dementia. There was no change in cardiovascular medication use among residents with CHD in ALFs with or without dementia over time. Antithrombotic use was lower in residents with dementia compared with residents without dementia in NHs (p < 0.001) and ALFs (p = 0.026); however, the interaction between dementia diagnosis and time was non-significant. Conclusions The decline in cardiovascular medication use in residents with CHD and dementia suggests Finnish physicians are adopting a more conservative approach to the management of cardiovascular disease in the NH population.

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“…Second, according to Delbaere's algorithm, polypharmacy confers high falls risk in residents who are unable to stand unaided. Cardiovascular medications have also been strongly linked to polypharmacy (Jokanovic et al, 2017). This could also be one possible explanation why residents at high falls risk were more likely to be using two or more psychotropics, but not using one psychotropic medication.…”

Section: Discussionmentioning

confidence: 99%

Use of Falls Risk Increasing Drugs in Residents at High and Low Falls Risk in Aged Care Services

et al. 2019

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Falls are associated with considerable morbidity and mortality in aged care services and falls risk increasing drugs (FRIDs) are often overlooked as a contributor to falls. This study aims to investigate the association between the risk of falling and use of FRIDs from aged care services. Inverse-probability-weighted multinomial logistic regression was used to estimate the association between falls risk and regular FRIDs in 383 residents from six Australian aged care services. Overall, residents at high and low falls risk had similar prevalence of FRIDs. Prevalence of antipsychotics and sedative-hypnotics was low. Residents at high falls risk had higher adjusted odds of using ≥2 psychotropic medications (odds ratio [OR] = 1.75, 95% confidence interval [CI] = 1.17-2.61) and ≥2 medications that cause/worsen orthostatic hypotension (OR = 3.59, 95% CI = 2.27-5.69). High prevalence of FRIDs was mainly attributable to medications for which residents had clinical indications. Clinicians appeared to have largely avoided FRIDs that explicit criteria deem potentially inappropriate for high falls risk.

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Prevalence and Variability in Medications Contributing to Polypharmacy in Long-Term Care Facilities

Cited by 15 publications

References 44 publications

Patterns of High-Dose and Long-Term Proton Pump Inhibitor Use: A Cross-Sectional Study in Six South Australian Residential Aged Care Services

Patterns of High-Dose and Long-Term Proton Pump Inhibitor Use: A Cross-Sectional Study in Six South Australian Residential Aged Care Services

Change in Prescribing for Secondary Prevention of Stroke and Coronary Heart Disease in Finnish Nursing Homes and Assisted Living Facilities

Use of Falls Risk Increasing Drugs in Residents at High and Low Falls Risk in Aged Care Services

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