Drug–drug interactions in nursing home residents: analysis from the COME-ON trial

Abstract

Background as a result of the high prevalence of polypharmacy in nursing homes (NHs), nursing home residents (NHRs) are exposed to numerous drug–drug interactions (DDIs) that can lead to adverse drug effects, and increased morbidity and mortality. Objectives to evaluate (i) the prevalence of DDIs among NHRs and its evolution over time, and (ii) factors associated with a favourable evolution. Design posthoc analysis of the COME-ON study, a cluster-randomised controlled trial aiming at reducing potentially inappropriate prescriptions in NHs, through the implementation of a complex intervention. Setting and subjects 901 NHRs from 54 Belgian NHs. Methods DDIs were identified using a validated list of 66 potentially clinically relevant DDIs in older adults. We defined a favourable evolution at 15 months as the resolution of at least one DDI present at baseline, without the introduction of any new DDI. Factors associated with a favourable evolution were analysed using multivariable logistic regression. Results at baseline, 475 NHRs (52.7%) were exposed to at least 1 DDI and 225 NHRs (25.0%) to more than one DDI. Most common DDI was ‘Concomitant use of at least three central nervous system active drugs’. At 15 months, we observed a 6.3% absolute decrease in DDI prevalence in intervention group, and a 1.0% absolute increase in control group. The intervention, older age and private NH ownership were significantly associated with a favourable DDI evolution. Conclusion a high prevalence of DDI in Belgian NHs was observed, but the COME-ON intervention was associated with a favourable evolution over time.

Efficacy and safety of direct oral anticoagulants in older adults with atrial fibrillation: a prospective single-centre cohort study

“…If the association between CKD and higher rates of thrombotic events has already been demonstrated [ 22 , 23 ], of interest is the correlation we found between polypharmacy and thrombotic complications among patients aged 85 years and older. This observation may depend on drug-drug interactions and reduced compliance to pharmacological therapy (including anticoagulant therapy), as already postulated elsewhere [ 24 , 25 ], as well as on the evidence that polypharmacy usually identifies a subset of multi-morbid and inherently frailer patients. Interestingly, presence of CKD and discontinuation of DOACs resulted the only variables associated with cardioembolic events in patients aged ≥ 85 years after additional analysis to minimize the confounding.…”

Pharmacological treatments and medication-related problems in nursing homes in Catalonia: a multidisciplinary approach

“…The majority of potential DDIs included SSRIs, tramadol, statins, acenocoumarol, and calcium channel blockers. Some of these potential interactions have also been described by other authors, such as SSRIs (Pasina et al, 2020), statins (Lion et al, 2023), and warfarin (Neidecker et al, 2012). This is a concern since tramadol increases the potential of seizures when it is administered with SSRIs, serotonin/norepinephrine reuptake inhibitors (SNRIs), and tricyclic antidepressants, among others.…”

Prescribed Versus Taken Polypharmacy and Drug–Drug Interactions in Older Cardiovascular Patients during the COVID-19 Pandemic: Observational Cross-Sectional Analytical Study

“…We assumed the prevalence of potentially serious DDIs ranging from 17% to 81% in patients during the pandemic [3][4][5][6]. We considered the acceptable margin of error of 5%, confidence level of 95%, and approximate population size of 20,000.…”

“…Up to 17% of older adults in Germany have at least one potential drug-drug interaction (DDI) [3]. Over half of nursing home residents (52.7%) are exposed to at least one DDI and 25.0% to more than one DDI [4]. Prevalence of DDIs in palliative care ranges from 31 to 75% across various health care settings [5].…”