Prognostic value of the quality indicator “concurrent use of three or more psychotropic drugs” among residents of long-term-care facilities

Bell, Jane; Taipale, Heidi; Soini, Helena; Pitkälä, Kaisu H.

doi:10.1007/s00228-009-0689-5

Cited by 9 publications

(4 citation statements)

References 7 publications

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“…The concomitant prescribing of more than one CNS medication is common in aged care homes [58,59,60,61,62,63,64,65,66,67]. This is a matter of concern, as combinations could lead to adverse outcomes.…”

Section: Discussionmentioning

confidence: 99%

An Evaluation of the Central Nervous System Medication Use and Frailty among Residents of Aged Care Homes in Malaysia

et al. 2017

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Background/Aims: Old age and institutionalization in care homes are associated with increased use of risk medications affecting the central nervous system (CNS). This study evaluated medication utilization and appropriateness; and assessed frailty among residents of Malaysian aged care homes. Methods: The subjects of this study included 202 elderly (≥65 years) residents of 17 aged care homes in suburban peninsular Malaysia. Frailty was measured using the Groningen Frailty Indicator (GFI) score and independence in daily living was measured as KATZ activity of daily living score. Medication appropriateness was assessed using the Medication Appropriateness Index (MAI) and 2015 Beers' criteria for Potentially Inappropriate Medication (PIM). Results: CNS medications constituted about 16% of the total, with an average of 0.8 ± 1.1 medications per resident, which reduced to 0.5 ± 0.8 medications after 3 months. Frailty (154/202) and polypharmacy (90/202) were highly prevalent in study subjects.Subjects on CNS medications had significantly higher GFI score (7.1 vs. 5.9; p = 0.031), polypharmacy (57.8 vs. 35.3%; p = 0.002), number of PIMs (0.9 vs. 0.2; p = 0.001), and mean summed MAI score (3.6 vs. 2.6; p = 0.015) than subjects not on CNS medications. Medication number was also significantly correlated with GFI (r = 0.194; p = 0.006) and KATZ (r = 0.141; p = 0.046) scores. Conclusion: Frailty and polypharmacy were highly prevalent among aged care home subjects taking CNS medications. These findings support the notion that periodic regular medication review should improve the overall use of medications in elderly patients.

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Section: Discussionmentioning

confidence: 99%

An Evaluation of the Central Nervous System Medication Use and Frailty among Residents of Aged Care Homes in Malaysia

et al. 2017

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“…Data collection took place over a 2-week period in September 2003 as part of a larger project that investigated the nutritional status of residents of longterm care facilities in Helsinki, Finland. [31][32][33][34] Data were collected by a nurse working in each ward who had been trained in resident assessment protocols. Cross-sectional data were collected using a structured questionnaire that included information on each resident's demographic factors, functional status, drug use, and documented diagnoses.…”

Section: Data Collectionmentioning

confidence: 99%

Anticholinergic Drug Use and Mortality Among Residents of Long-Term Care Facilities: A Prospective Cohort Study

Kumpula

Bell

Soini³

et al. 2011

The Journal of Clinical Pharmacology

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Few studies have investigated the possible association between use of anticholinergic drugs and mortality. The objectives of this study were to investigate the prevalence and determinants of anticholinergic drug use and the possible association between anticholinergic drug use and mortality. Data were obtained from 53 long-term care wards in Helsinki, Finland, in 2003. Medication, diagnostic, and mortality data were available for 1004 residents. Each resident's anticholinergic load was calculated using the Anticholinergic Risk Scale (ARS). Cox proportional hazards models were used to investigate the risk of death among users with a mild anticholinergic load (ARS score 1-2) and high load (ARS score ≥3) compared with nonusers of anticholinergic drugs. Age, sex, and nutritional status were used as covariates. Among the 1004 residents, 455 (45%) were nonusers of anticholinergic drugs, 363 (36%) had a mild anticholinergic load, and 186 (19%) had a high anticholinergic load. One-year all-cause mortality rates were 28%, 29%, and 27%, respectively. Higher ARS scores were not associated with mortality (ARS score 1-2: hazard ratio 1.08; 95% confidence interval, 0.84-1.41; ARS score ≥3: hazard ratio 1.05; 95% confidence interval, 0.75-1.46). Anticholinergic drug use was common; however, high ARS scores were not associated with mortality. Further research is needed using alternative models and among different resident populations.

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“…The use of psychotropics is substantial in the nursing home setting, and is associated with ADRs and falls [ 22 , 23 ]. In some research, the variable of three or more concomitant psychotropic drugs has been used as a substitute variable for potentially inappropriate psychotropic use [ 24 , 25 ].…”

Section: Introductionmentioning

confidence: 99%

Potentially inappropriate medication use in nursing homes: an observational study using the NORGEP-NH criteria

et al. 2017

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BackgroundFrail residents in the nursing home sector call for extra care in prescribing. The Norwegian General Practice Nursing Home (NORGEP-NH) list of 34 explicit criteria for potentially inappropriate medication use in nursing homes was developed explicitly for this population. The aim of this study was to employ the NORGEP-NH Criteria to study the extent of potentially inappropriate medication use among nursing home residents and explore possible associated factors.MethodsCross-sectional observational pharmacoepidemiological study from residents in nursing homes in the county of Vestfold, Norway. Data collected 2009–11 included residents’ demographic and clinical status and all medications, regular and on demand.Results881 patients from 30 institutions (mean 85.9 years, 68.6% female), were included. According to NORGEP-NH, 43.8% were prescribed at least one potentially inappropriate regular medication, and 9.9% regularly received three or more potentially inappropriate medications. When also including a) the NORGEP-NH Deprescribing Criteria and b) including drugs prescribed for use as needed, 92.7% of all residents received medication that needs particular surveillance according to the NORGEP-NH. 69.7% of the nursing home residents used at least one psychotropic drug regularly. Female residents received more often than males at least one potentially inappropriate regular medication (OR 1.60, p=0.007). Regarding the prescription of three or more concomitant psychotropic medications, odds ratio for females was 1.79 (p=0.03) compared to males. Residents with the best performance in activities of daily living, and residents residing in long-term wards, had higher risk of using three or more psychotropic drugs. Use of multiple psychoactive drugs increased the risk of falls in the course of an acute episode of infection or dehydration (odds ratio 1.70, p=0.009).ConclusionsPrevalence of potentially inappropriate medications in nursing homes according to the NORGEP-NH was extensive, and especially the use of multiple psychotropic drugs. The high prevalence found in this study shows that there is a need for higher awareness of medication use and side effects in the elderly population.Trial registrationRetrospectively registered. Data obtained from clinical trial NCT01023763 registered with ClinicalTrials.gov 12/01/2009.

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Prognostic value of the quality indicator “concurrent use of three or more psychotropic drugs” among residents of long-term-care facilities

Abstract: value of the quality indicator "concurrent use of three or more psychotropic drugs" among residents of long-term-care facilities.

Cited by 9 publications

References 7 publications

An Evaluation of the Central Nervous System Medication Use and Frailty among Residents of Aged Care Homes in Malaysia

An Evaluation of the Central Nervous System Medication Use and Frailty among Residents of Aged Care Homes in Malaysia

Anticholinergic Drug Use and Mortality Among Residents of Long-Term Care Facilities: A Prospective Cohort Study

Potentially inappropriate medication use in nursing homes: an observational study using the NORGEP-NH criteria

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