Cross-national comparison of medication use in Australian and Dutch nursing homes

Taxis, Katja; Kochen, Sjoerd; Wouters, Hans; Boersma, Froukje; Gerard, Maring Jan; Mulder, Hans; Pavlovic, Jugoslav; Stevens, Gerard; McLachlan, Andrew J.; Pont, Lisa G.

doi:10.1093/ageing/afw218

Cited by 15 publications

(18 citation statements)

References 15 publications

(17 reference statements)

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“…Anticholinergic/sedative medications mostly act on the central nervous system (CNS) and include psycholeptics, psychoanaleptics, and analgesics . So far, most research has focused on quantifying the cumulative exposure of multiple anticholinergic/sedative medications in older patients with polypharmacy . Little is known about the prevalence of combinations of multiple anticholinergic/sedative medications resulting in a high load or whether subgroups of these patients based on types of anticholinergic/sedative medications used can be identified.…”

Section: Introductionmentioning

confidence: 99%

Anticholinergic and sedative medication use in older community‐dwelling people: A national population study in the Netherlands

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Taxis

Teichert

et al. 2019

Pharmacoepidemiology and Drug

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Purpose To identify the proportion of older adults with a high anticholinergic/sedative load and to identify patient subgroups based on type of central nervous system (CNS)‐active medication used. Methods A cross‐sectional study of a nationwide sample of patients with anticholinergic/sedative medications dispensed by 1779 community pharmacies in the Netherlands (90% of all community pharmacies) in November 2016 was conducted. Patients aged older than 65 years with a high anticholinergic/sedative load defined as having a drug burden index (DBI) greater than 1 were included. Proportion of patients with a high anticholinergic/sedative load was calculated by dividing the number of individuals in our study population by the 2.4 million older patients using medications dispensed from study pharmacies. Patient subgroups based on type of CNS‐active medications used were identified with latent class analysis. Results Overall, 8.7% (209 472 individuals) of older adults using medications had a DBI greater than 1. Latent class analysis identified four patient subgroups (classes) based on the following types of CNS‐active medications used: “combined psycholeptic/psychoanaleptic medication” (class 1, 57.9%), “analgesics” (class 2, 17.9%), “antiepileptic medication” (class 3, 17.8%), and “anti‐Parkinson medication” (class 4, 6.3%). Conclusions A large proportion of older adults in the Netherlands had a high anticholinergic/sedative load. Four distinct subgroups using specific CNS‐active medication were identified. Interventions aiming at reducing the overall anticholinergic/sedative load should be tailored to these subgroups.

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Section: Introductionmentioning

confidence: 99%

Anticholinergic and sedative medication use in older community‐dwelling people: A national population study in the Netherlands

Meer

Taxis

Teichert

et al. 2019

Pharmacoepidemiology and Drug

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“…Long-term residential aged care or nursing home residents are among the frailest of all older populations. They are generally medically complex, using a high number of medications, and this complexity together with age-related pharmacokinetic- and dynamic puts them at high risk of adverse outcomes related to medication ( Taxis et al, 2016 , 2017 ; Australian Institute of Health and Welfare, 2017 ).…”

Section: Introductionmentioning

confidence: 99%

Changes in Prescribing Symptomatic and Preventive Medications in the Last Year of Life in Older Nursing Home Residents

2018

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Background: At the end of life goals of care change from disease prevention to symptomatic control, however, little is known about the patterns of medication prescribing at this stage.Objectives: To explore changes in prescribing of symptomatic and preventive medication in the last year of life in older nursing home residents.Methods: A retrospective cohort study was conducted using pharmacy medication supply data of 553 residents from 16 nursing home facilities around Sydney, Australia. Residents received 24-h nursing care, were aged ≥ 65 years, died between June 2008 and June 2010 and were using at least one medication 1 year before death. Medications were classified as symptomatic, preventive, or other. A linear mixed model was used to compare changes in prescribing in the last year of life.Results: 68.1% of residents were female, mean age was 88.0 (SD: 7.5) years and residents used a mean of 9.1 (SD: 4.1) medications 1 year before death. The mean number of symptomatic medications per resident increased from 4.6 medications 1 year before death to 5.1 medications at death [95% CI 4.4–4.7 to 5.9–5.2, P = 0.000], while preventive medication decreased from 2.0 to 1.4 medications [95% CI 1.9–2.1 to 1.3–1.5, P = 0.000]. Symptomatic medications were used longer in the last year of life, compared to preventive medications (336.3 days [95% CI 331.8–340.8] versus 310.9 days [95% CI 305.2–316.7], P = 0.000).Conclusion: Use of medications for symptom relief increased throughout the last year of life, while medications for prevention of long-term complications decreased. But changes were slight and clinical relevance can be questioned.

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“…This may at least partly account for the absence of a relationship between DBI and functional outcomes and warrants a careful generalization of our results to other NH populations with dementia. Lastly, Dutch NHs might be inherently different in terms of drug-prescribing practices compared with NHs in other countries [ 65 ]. Therefore, we urge caution in generalization of these results to other NHs.…”

Section: Discussionmentioning

confidence: 99%

Relationship between drug burden and physical and cognitive functions in a sample of nursing home patients with dementia

Sanders

Hortobágyi

Staveren

et al. 2017

Eur J Clin Pharmacol

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Purpose The Drug Burden Index (DBI) is a tool to quantify the anticholinergic and sedative load of drugs. Establishing functional correlates of the DBI could optimize drug prescribing in patients with dementia. In this cross-sectional study, we determined the relationship between DBI and cognitive and physical functions in a sample of patients with dementia.Methods Using performance-based tests, we measured physical and cognitive functions in 140 nursing home patients aged over 70 with all-cause dementia. We also determined anticholinergic DBI (AChDBI) and sedative DBI (SDBI) separately and in combination as total drug burden (TDB). Results Nearly one half of patients (48%) used at least one DBI-contributing drug. In 33% of the patients, drug burden Key statements What is already known about this subject The Drug Burden Index (DBI) is considered as a broadly applicable tool to quantify anticholinergic and sedative drug burden. In healthy older adults, the DBI is associated with physical and cognitive impairments. In older patients with dementia, this has not yet been investigated. What this study addsWe found that DBI is unrelated to cognitive and physical functions in a sample of 140 nursing home patients with dementia. These results may imply that drug prescribing is more optimal for patients with dementia compared with healthy older populations.Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00228-017-2319-y) contains supplementary material, which is available to authorized users. Clin Pharmacol (2017) 73:1633-1642 DOI 10.1007/s00228-017-2319 was moderate (0 < TDB < 1) whereas in 15%, drug burden was high (TDB ≥ 1). Multivariate models yielded no associations between TDB, AChDBI, and SDBI, and physical or cognitive function (all p > 0.05).Conclusions A lack of association between drug burden and physical or cognitive function in this sample of patients with dementia could imply that drug prescribing is more optimal for patients with dementia compared with healthy older populations. However, such an interpretation of the data warrants scrutiny as several dementia-related factors may confound the results of the study.

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Cross-national comparison of medication use in Australian and Dutch nursing homes

Cited by 15 publications

References 15 publications

Anticholinergic and sedative medication use in older community‐dwelling people: A national population study in the Netherlands

Anticholinergic and sedative medication use in older community‐dwelling people: A national population study in the Netherlands

Changes in Prescribing Symptomatic and Preventive Medications in the Last Year of Life in Older Nursing Home Residents

Relationship between drug burden and physical and cognitive functions in a sample of nursing home patients with dementia

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