Education to Reduce Potentially Harmful Medication Use Among Residents of Assisted Living Facilities: A Randomized Controlled Trial

Pitkälä, Kaisu H.; Juola, Anna-Liisa; Kautiainen, Hannu; Soini, Helena; Finne‐Soveri, U. Harriet; Bell, Jane; Björkman, Mikko

doi:10.1016/j.jamda.2014.04.002

Cited by 91 publications

(124 citation statements)

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“…We have demonstrated that training nurses to recognize potentially harmful medications and bring these to the attention of the treating physician can improve prescribing and maintain health-related quality of life. 30 Our present results highlight the potential value of widespread implementation of nurse education in nursing homes and assisted living facilities. Our study did not assess the provision of nonpharmacological treatment or the prescribed doses of medications.…”

Section: Discussionmentioning

confidence: 51%

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Eight-Year Trends in the Use of Opioids, Other Analgesics, and Psychotropic Medications Among Institutionalized Older People in Finland

Pitkälä

Juola

Hosia

et al. 2015

Journal of the American Medical Directors Association

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Section: Discussionmentioning

confidence: 51%

“…28 More than 80% of institutionalized residents in Finland are prescribed one or more psychotropic medications. 29,30 Psychotropic medications have been associated with an increased risk of falls 31 and cognitive decline. 32,33 Use of antipsychotics in people with dementia has been associated with an increased risk of stroke and death.…”

mentioning

confidence: 99%

Eight-Year Trends in the Use of Opioids, Other Analgesics, and Psychotropic Medications Among Institutionalized Older People in Finland

Pitkälä

Juola

Hosia

et al. 2015

Journal of the American Medical Directors Association

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“…Deprescribing involves a completion of a review of an individual's current medications and subsequent withdrawal of inappropriate medications with supervision from a healthcare professional after careful consideration of the likelihood of adverse events with a goal of improving clinical outcomes [26,27]. Interventions for deprescribing have been trialled in residential aged care facilities, however the effects of these interventions as shown in randomised controlled trials (RCTs) have been mixed and further studies are required [28][29][30][31][32][33]26]. The high prevalence of DBIassociated medications and PIMs according to the Beers Criteria in the current study suggests that current recommendations for appropriate medication use in older adults may need to be better implemented in residential aged care settings.…”

Section: Discussionmentioning

confidence: 99%

Associations between the Drug Burden Index, Potentially Inappropriate Medications and Quality of Life in Residential Aged Care

et al. 2018

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Background: Inappropriate polypharmacy may negatively impact quality of life of residents in aged care facilities, but it remains unclear which medications may influence this reduced quality of life.Objective: The objective was to examine whether the Drug Burden Index (DBI) and potentially inappropriate medications (PIMs), were associated with quality of life in older adults living in residential care with a high prevalence of cognitive impairment and dementia.Methods: Cross-sectional analyses of 541individuals recruited from 17 residential aged care facilities in Australia in the Investigating Services Provided in the Residential Environment for Dementia (INSPIRED) study. Quality of life was measured using the EQ-5D-5L (a measure of generic quality of life) and the DEMQOL (a measure developed for use in dementia) completed by the participant or a proxy.Results: In the 100 days prior to recruitment, 83.1% of the participants received at least one anticholinergic or sedative medication included in the DBI and 82.7% received at least one PIM according to the Beers Criteria. Multi-level linear models showed there was a significant association between higher DBI and lower quality of life according to the EQ-5D-5L (β (SE): -0.034 (0.012), p=0.006) after adjustment for potential confounding factors. Increasing numbers of PIMs were also associated with lower EQ-5D-5L scores (-0.030 (0.010), p=0.003) and DEMQOL-Self-Report-Utility scores (-0.020 (0.009), p=0.029). Exposure to both DBI-associated medications and PIMs was associated with lower DEMQOL-SelfReport-Utility scores (-0.034 (0.017), p=0.049).Conclusion: Exposure to anticholinergic and sedative medications and PIMs occurred in over three-quarters of a population of older adults in residential care and was associated with a lower quality of life.  This study provides evidence to support that there is a need for greater adherence to recommendations for appropriate medication use in residential aged care.

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“…15D is a generic, 15-dimensional instrument concerning different aspects of HRQoL [33, 34] that has been used in similar geriatric interventions [35, 36]. The dimensions are mobility, vision, hearing, breathing, sleeping, eating, speech, elimination, usual activities, mental function, discomfort and symptoms, depression, distress, vitality and sexual activity.…”

Section: Methodsmentioning

confidence: 99%

Cooperation between geriatricians and general practitioners for improved pharmacotherapy in home-dwelling elderly people receiving polypharmacy – the COOP Study: study protocol for a cluster randomised controlled trial

Romskaug

Molden

Straand

et al. 2017

Trials

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BackgroundPolypharmacy and inappropriate drug use is associated with negative health outcomes among older people. Various interventions for improving drug treatment have been evaluated, but the majority of studies are limited by the use of surrogate outcomes or suboptimal design. Thus, the potential for clinically significant improvements from different interventions is still unclear. The main objective of this study is therefore to evaluate the effect upon patient-relevant endpoints of a cooperation between geriatricians and general practitioners on complex drug regimens in home-dwelling elderly people.MethodsThis is a cluster randomised, single-blind, controlled trial where general practitioners are invited to participate with patients from their lists. The patients must be 70 years or older, use at least seven different medications and have their medications administered by the home nursing service. We plan to recruit 200 patients, with randomisation at physician level. The intervention consists of three main parts: (1) clinical geriatric assessment of the patient, combined with a thorough review of their medications; (2) a meeting between the geriatrician and general practitioner, where the two physicians combine their competence and knowledge and discuss the drug list systematically; (3) clinical follow-up, depending on the medication changes that have been done. The study period is 24 weeks, and the patients are assessed at baseline, 16 and 24 weeks. The primary outcome measure is health-related quality of life according to the 15D instrument. Secondary outcome measures include physical and cognitive functioning, medication appropriateness, falls, carer burden, use of health services (hospital or nursing home admissions, use of home nursing services) and mortality.DiscussionOur choice of patient-relevant outcome measures will hopefully provide new knowledge on the potential for clinical improvements after performing comprehensive medication reviews in home-dwelling elderly people receiving polypharmacy.Trial registrationClinicalTrials.gov, NCT02379455. Registered on 27 February 2015.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-017-1900-0) contains supplementary material, which is available to authorized users.

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Education to Reduce Potentially Harmful Medication Use Among Residents of Assisted Living Facilities: A Randomized Controlled Trial

Cited by 91 publications

References 44 publications

Eight-Year Trends in the Use of Opioids, Other Analgesics, and Psychotropic Medications Among Institutionalized Older People in Finland

Eight-Year Trends in the Use of Opioids, Other Analgesics, and Psychotropic Medications Among Institutionalized Older People in Finland

Associations between the Drug Burden Index, Potentially Inappropriate Medications and Quality of Life in Residential Aged Care

Cooperation between geriatricians and general practitioners for improved pharmacotherapy in home-dwelling elderly people receiving polypharmacy – the COOP Study: study protocol for a cluster randomised controlled trial

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