Effect of comprehensive pharmaceutical services on drug use in long-term care facilities

Prescribing for the Elderly: Part II Prescribing Patterns: Differences Due to Age

“…Care of the elderly living in long‐term institutions has attracted much attention in the United States. Numerous studies on prescribing for this tiny sector of the community (less than 5% of all persons aged 65 years or older) have been published 36–49 …”

“…The introduction of clinical pharmacists to monitor drug use in American nursing homes has been associated with a decrease in the number of prescribed drugs taken per patient from seven to five. Many studies have shown that substantial reductions (12% to 39%) in the number of medicines prescribed are possible with no apparent untoward consequences to the patient 43–49 …”

Reducing Polypharmacy in the Elderly

“…Polypharmacy, or the administration of multiple medications to an individual patient, is a problem in ambulatory, 1 – 3 hospitalized, 4 – 6 and nursing home populations 7 – 10 . The consequences of polypharmacy include adverse drug reactions, 1 , 11 – 14 diminished patient compliance, 15 – 18 and increased health care costs 19 , 20 . In selected conditions, such as cancer and bacterial infections, combination therapy is well established.…”

“…Previous studies showing successful reduction in polypharmacy have largely been uncontrolled and have focused on special populations, such as epileptic, 14,23–25,29 psychiatric, 26 , 27 , 30 or nursing home patients 9 , 19 , 20 . Two controlled trials involving outpatients have shown that simply providing physicians a list of their patients' current medications does not decrease the number of drugs prescribed 31 , 32 .…”

“…Two controlled trials involving outpatients have shown that simply providing physicians a list of their patients' current medications does not decrease the number of drugs prescribed 31 , 32 . However, review of drug regimens followed by specific recommendations to prescribing physicians has reduced polypharmacy in one controlled 6 , 33 and several uncontrolled 19 , 20 , 30 trials.…”