Medications in Post-Acute and Long-Term Care: Challenges and Controversies

Abstract

Nursing Homes post-acute care long-term care medications prescribing deprescribing Pharmaceutical agents are a valuable resource to assist in the care of older persons. Their use in post-acute and long-term care settings is particularly notabledfor example, the proportion of nursing home residents taking 9 or more medications increased from 18% in the mid-1990s to 40% less than 15 years later. 1,2 Average drug counts are similarly high around the world, although there is considerable variation in use between settings and countries. 3,4 High medication use occurs despite the fact that persons with advanced age and multimorbidity are particularly susceptible to drug adverse effects due to physiological changes such as declines in hepatic and renal clearance. Further, the probability of deleterious drug interactions rises exponentially as the number of medications increases. 5 Why are so many drugs administered in post-acute and long-term care, and why does the number keep rising? One reason is because new and better agents have been developed for a variety of conditions common in nursing homes, which relieve or prevent morbidity and delay mortality. Many of these newer medications, such as bisphosphonates for fracture prevention, angiotensin-converting enzyme inhibitors for diabetic renal protection, and beta blockers for coronary artery disease, have strong data in the nursing home literature supporting their use. Other reasons for increasing drug lists, however, are less clearly good for patients. In some cases,The authors declare no conflicts of interest.

Post-acute long-term care COVID-19 medication optimization survey: Informing medication management initiatives

“…One of the main strengths of this study is that the topic of medication optimization in PA-LTC and how to address from an interdisciplinary perspective is under studied. 8 Despite the low survey response rate at 7.8%, we believe that these findings provide preliminary data for future research. It is important to note, that other web-based surveys of practitioners were also noted to range from 7% to 15% depending on whether incentives were given or not.…”

“…Additionally, there were multiple lessons learned from the rapid development as well as implementation of the MMG during the pandemic which can help to propel pragmatic clinical trials that will help us to reimagine medication management initiatives in PA-LTC. 8 For instance, comments suggested that this pandemic-centered MMG should be adapted into a post-pandemic guideline that can further tactics to address medication burden. For instance, aligning existing work such as advanced care planning focusing on resident-centered goals of care while discussing the continued needs of medications and potentially unnecessary monitoring (e.g., multiple finger sticks for serum glucose testing) helped to reduce the burden on the direct care staff and the residents.…”

Comprehensive Geriatric Assessment

“…Appropriate medication use is a challenge in all settings including the post-acute and long-term care sites; the proportion of nursing home residents taking nine or more medications has more than doubled in the past two decades, although prescribing trends differ based on locations. There is call for up-to-date lists, medication reconciliation, deprescribing, and keeping the regimen simple, while being cognizant of adverse drug effects (Sloane et al 2021).…”