Frailty and Potentially Inappropriate Medication Use at Nursing Home Transition

Maclagan, Laura C.; Maxwell, Colleen J.; Gandhi, Sima; Guan, Jun; Bell, Chaim M.; Hogan, David B.; Daneman, Nick; Gill, Sudeep S.; Morris, Andrew M.; Jeffs, Lianne; Campitelli, Michael A.; Seitz, Dallas; Bronskill, Susan E.

doi:10.1111/jgs.15016

Cited by 66 publications

(74 citation statements)

References 48 publications

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“…As in previous work, 5 we used assessment items from the RAI-MDS to calculate a validated frailty index for each resident; residents were considered frail if their frailty index score was 0.3 or greater. RAI-MDS data were also used to determine demographic information and specific clinical diagnoses, including Alzheimer's and related dementias (henceforth referred to as dementia).…”

Section: Resident Characteristicsmentioning

confidence: 99%

“…T he use of benzodiazepines in nursing homes (NHs) has long been scrutinized because of known adverse events such as falls, fractures, and cognitive impairment, as well as concerns about dependency. [1][2][3][4][5] Benzodiazepines feature prominently in priority lists for deprescribing in older adults 6 , and rates of benzodiazepine prescribing have been identified as important indicators of quality and safety of care. 7 In an attempt to reduce potentially inappropriate use, many jurisdictions publically report rates of psychotropic drugs-many having done so for longer than a decade.…”

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confidence: 99%

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Low‐Dose Trazodone, Benzodiazepines, and Fall‐Related Injuries in Nursing Homes: A Matched‐Cohort Study

Bronskill

Campitelli

Iaboni

et al. 2018

J American Geriatrics Society

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Objectives To evaluate whether risk of fall‐related injuries differs between nursing home (NH) residents newly dispensed low‐dose trazodone and those newly dispensed benzodiazepines. Design Retrospective, matched cohort study in linked, population‐based administrative data. Matching was based on propensity score ( ± 0.2 standard deviations of the score as a caliper), age ( ± 1 year), sex, frailty status, and history of dementia. The derived propensity score included demographic characteristics, clinical comorbidities, cognitive and functional status, and risk factors for falls. Setting All NHs in Ontario, Canada. Participants Propensity score–matched pairs of residents aged 66 and older who received a full clinical assessment between April 1, 2010, and March 31, 2015 (N=7,791). Measurements Hospitalization (emergency department visit or acute care admission) for a fall‐related injury within 90 days of exposure. Subdistribution hazard functions accounted for competing risk of death. Sensitivity analyses were used to examine falls resulting in hip or wrist fracture only, as well as different lengths of follow‐up at 30, 60, and 180 days. Results Cumulative incidence of a fall‐related injury in the 90 days after index was 5.7% for low‐dose trazodone users and 6.0% for benzodiazepine users (between‐group change=–0.29, 95% confidence interval (CI)=–1.02–0.44]; hazard ratio=0.94, 95% CI=0.83–1.08). Findings were consistent across sensitivity analyses. Conclusion New use of low‐dose trazodone was no safer with respect to a risk of a fall‐related injury than new use of benzodiazepines. Additional studies to compare the effectiveness and risks of low‐dose trazodone with those of a variety of psychotropic drug therapies are required in light of increasing trends in the use of trazodone in NHs.

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Section: Resident Characteristicsmentioning

confidence: 99%

mentioning

confidence: 99%

Low‐Dose Trazodone, Benzodiazepines, and Fall‐Related Injuries in Nursing Homes: A Matched‐Cohort Study

Bronskill

Campitelli

Iaboni

et al. 2018

J American Geriatrics Society

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“…Harrison et al depicted similar findings in a cross-sectional study with a significant association between higher DBI and poorer QOL, as well as increasing PIMs and poorer QOL [36]. This can be explained by the nature of inappropriate medication use, which commonly leads to adverse outcomes that affects participants' morbidity and QOL [37,38]. In contrast, there was a statistically significant and negative association between medication inappropriateness and dependency.…”

Section: Discussionmentioning

confidence: 67%

“…This, however, contradicts several studies that have reported a positive correlation between both parameters. This could be due to the setting of this study as the participants were non-institutionalized individuals with better health status [38,39] than those in settings such as aged-care facilities, nursing homes and retirements villages [36,37].…”

Section: Discussionmentioning

confidence: 99%

Associations between Drug Burden Index, medication appropriateness and patient-reported outcomes in the community pharmacy setting in Malaysia

Hasan

Liew

Chong

et al. 2018

Drugs Ther Perspect

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Introduction The increasing complexity of drug regimens over time and the use of multiple medications exposes older patients to a greater risk of receiving inappropriate medications. The study aims to investigate whether drug burden index (DBI) and potentially inappropriate medications (PIMs) were associated with patient-reported health outcomes (PROs) in community-dwelling older adults (aged ≥60 years) in Malaysia. Methods DBI used to quantify patients' exposure to anticholinergic and sedative medications in a cross-sectional sample of older individuals from the community pharmacy setting in Malaysia. PIMs (based on Beers criteria), potentially inappropriate prescribing (PIP; based on STOPP criteria) and polypharmacy (use of ≥ 5 concurrent medications) used to quantify exposure to in appropriate medications. PROs were investigated using the Groningen Frailty Indicator (GFI) for frailty, and Older People's Quality of Life-35 (OPQOL) for quality of life (QOL). The adjusted associations between DBI, medication inappropriateness and PROs were analyzed. Results More than half of the study participants received ≥ 1 anticholinergic or sedative medication (mean 0.47/participant; range 0.0-2.14). Prevalence of frailty was low; 8.90% of patients with a mean GFI score of 1.67 (range 1-8) and was significantly and positively correlated with DBI (r 0.253; p = 0.003). In multivariate logistic regression, frailty was found to be significantly associated with the odds of receiving DBI-associated medications (odds ratio 1.44; 95% CI 1.02-2.02, p = 0.039). Non-significant associations between DBI and QOL domains, except significant and positive correlation between independence domain of OPQOL and PIPs. Conclusion The study indicates a significant relationship between drug burden measured by DBI, and frailty measured by GFI. The prescribers managing various medical conditions of older people should consider frailty and other relevant physical health parameters as important health outcomes.

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“…26,27 The frailty index for each resident was the ratio of the number of deficits present to the number considered. As in previous work, 28,29 nonfrail, prefrail, and frail residents were defined based on scores of <0.2, 0.2 -0.3, and >0.3, respectively. We also looked back 1 year for previous healthcare utilization, including number of emergency department (ED) visits, number of inpatient admissions, and number of unique prescription drugs.…”

Section: Long-term Care Resident Characteristicsmentioning

confidence: 99%

The Association of Resident Communication Abilities and Antibiotic Use in Long‐Term Care

Saxena¹,

Bronskill²,

Brown

et al. 2019

J American Geriatrics Society

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OBJECTIVES To determine whether decreased communication ability among long‐term care residents is associated with increased antibiotic exposure. DESIGN Retrospective cohort study. SETTING All long‐term care homes in Ontario, Canada. PARTICIPANTS All adults aged 66 years or older residing in long‐term care and undergoing a full assessment between January 1 and December 31, 2016 (N = 87,947). MEASUREMENTS Data were obtained from linkable, population‐wide administrative data sets. Residents were identified, and characteristics were abstracted from the Resident Assessment Instrument Minimum Dataset version 2.0. The primary predictors of interest were residents' ability to make themselves understood and ability to understand others. The primary outcome was antibiotic days of treatment per 1000 resident days in the 90 days following assessment (obtained from the Ontario Drug Benefits Database). RESULTS Those who were sometimes/rarely/never able to make themselves understood received 50.7 antibiotic days per 1000 person‐days of follow‐up, compared to 62.1 received by those who were able to make themselves understood. Those who were sometimes/rarely/never able to understand others received 50.0 antibiotic days per 1000 person‐days of follow‐up, compared to 61.4 by those who were able to understand others. Multivariable Poisson regression, accounting for resident characteristics, confirmed that compared to those with highest levels of communication ability, those who could sometimes/rarely/never make themselves understood had significantly fewer days on antibiotics (rate ratio [RR] = 0.76; confidence interval [95% CI] = 0.73‐0.79) as did those who could sometimes/rarely/never understand others (RR = 0.76; 95% CI = 0.74‐0.79). CONCLUSION Poor resident communication ability is not a driver of antibiotic overuse in long‐term care. In fact, lower ability to understand others and/or be understood by others is associated with less antibiotic exposure. Further work is needed to optimize antibiotic use in long‐term care residents across the entire spectrum of communication skills.

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Frailty and Potentially Inappropriate Medication Use at Nursing Home Transition

Cited by 66 publications

References 48 publications

Low‐Dose Trazodone, Benzodiazepines, and Fall‐Related Injuries in Nursing Homes: A Matched‐Cohort Study

Low‐Dose Trazodone, Benzodiazepines, and Fall‐Related Injuries in Nursing Homes: A Matched‐Cohort Study

Associations between Drug Burden Index, medication appropriateness and patient-reported outcomes in the community pharmacy setting in Malaysia

The Association of Resident Communication Abilities and Antibiotic Use in Long‐Term Care

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