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

(92 reference statements)

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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%

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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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Section: Discussionmentioning

confidence: 67%

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

View full text Add to dashboard Cite

show abstract

“…2,12,13 Assessment items from the RAI-MDS 2.0 provided measures of clinical diagnoses, functional status and cognitive performance; they were also used to calculate a validated measure of resident frailty. 14,15 This index of frailty covers many domains of health and is calculated as the proportion of accumulated to potential health deficits (from 72 RAI-MDS items) whereby those with greater than 30% of potential deficits are defined as frail. We used the Johns Hopkins Adjusted Clinical Groups® case-mix system (version 10.0) to compute the number of Aggregated Diagnosis Groups in the past 2 years as a general measure of comorbidity.…”

Section: Discussionmentioning

confidence: 99%

One-year survival and admission to hospital for cardiovascular events among older residents of long-term care facilities who were prescribed intensive- and moderate-dose statins

Campitelli

Maxwell

Maclagan

et al. 2019

CMAJ

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tatins (hydroxymethylglutaryl-CoA reductase inhibitors) are used widely in persons of advanced age and in those living in long-term care facilities. 1,2 In Ontario, Canada, over one-third of all residents of long-term care facilities are prevalent statin users, including 28% of frail residents who have a limited likelihood of 1-year survival; nearly one-quarter of prevalent users received high doses. 2 Historically, however, randomized clinical trials studying the efficacy and safety of statins rarely include adults aged 75 years and older, 3 and most have not included residents of long-term care facilities. 4 This leaves clinicians with little guidance when making ongoing decisions about treatment with statins, such as the appropriate dosing of statin medications, for patients in long-term care facilities and other populations of older adults. An observed threefold difference in the median proportion of residents in long-term care facilities receiving statins between high-and low-rate prescribers highlights the uncertainty faced by clinicians when making treatment decisions. 2

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“…We used the RAI-MDS 2.0 data to identify assessments with a concurrent diagnosis of Alzheimer disease or other dementia, and liver disease or renal failure. 23 We also used assessment items from the RAI-MDS 2.0 to compute a validated measure of resident frailty, 24,25 which included 72 deficits covering multiple domains of health (disease diagnoses, functional status, psychosocial well-being, cognition and communication). In accordance with previous work, [24][25][26] we defined residents with more than 30% of potential deficits as frail.…”

Section: Resident Characteristicsmentioning

confidence: 99%

“…23 We also used assessment items from the RAI-MDS 2.0 to compute a validated measure of resident frailty, 24,25 which included 72 deficits covering multiple domains of health (disease diagnoses, functional status, psychosocial well-being, cognition and communication). In accordance with previous work, [24][25][26] we defined residents with more than 30% of potential deficits as frail. We used a measure of pain frequency in the RAI-MDS 2.0 to identify residents who experienced daily pain, less than daily pain or no pain in the 7 days before assessment.…”

Section: Resident Characteristicsmentioning

confidence: 99%

Time trends in opioid prescribing among Ontario long-term care residents: a repeated cross-sectional study

Iaboni

Campitelli

Bronskill

et al. 2019

cmajo

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Background: Opioids are an important pain therapy, but their use may be associated with adverse events in frail and cognitively impaired long-term care residents. The objective of this study was to investigate trends in opioid prescribing among Ontario long-term care residents over time, given the paucity of data for this setting. Methods: We used linked clinical and health administrative databases to conduct a population-based, repeated cross-sectional study of opioid use among Ontario long-term care residents between Apr. 1, 2009, and Mar. 31, 2017. We identified prevalent opioid use by drug type, dosage and coprescription with benzodiazepines, and within certain vulnerable subgroups. We used log-binomial regression to quantify the percent change between 2009/10 and 2016/17. Results: Among an average of 76 147 long-term care residents per year, the prevalence of opioid use increased from 15.8% in 2009/10 to 19.6% in 2016/17 (p < 0.001). Over the study period, the use of hydromorphone increased by 233.2%, whereas the use of all other opioid agents decreased. The use of high-dose opioids (> 90 mg of morphine equivalents) and the coprescription of opioids with benzodiazepines decreased significantly, by 17.7% (p < 0.001) and 23.8% (p < 0.001), respectively. Increases in opioid prevalence were more notable among frail residents (37.6% v. 18.8% among nonfrail residents, p < 0.001) and those with dementia (38.6% v. 21.6% among those without dementia, p < 0.001). Interpretation: Within Ontario long-term care, trends suggest a shift toward increased use of hydromorphone but reduced prevalence of use of other opioid agents and potentially inappropriate opioid prescribing. Further investigation is needed on the impact of these trends on resident outcomes.

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Frailty and Potentially Inappropriate Medication Use at Nursing Home Transition

Cited by 66 publications

References 48 publications

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

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

One-year survival and admission to hospital for cardiovascular events among older residents of long-term care facilities who were prescribed intensive- and moderate-dose statins

Time trends in opioid prescribing among Ontario long-term care residents: a repeated cross-sectional study

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