Prescribing for older people in nursing homes: a review of the key issues

Abstract

Prescribing of medication is one of the most common interventions that residents in nursing homes will experience. There is little doubt that medication has greatly contributed to improvements in symptom control, long-term management of medical conditions and greater longevity. However, the quality of prescribing has also been criticised and this paper outlines the issues that have proved to be most problematic and have been repeatedly highlighted in the literature. There have been numerous reports of over-use of inappropriate medicines for which there is no clinical indication or for which there is little evidence of effectiveness, and under-use of medicines that would be indicated for residents with certain medical conditions. Residents may also suffer from adverse drug events and enforced or erratic compliance. Some of these problems may arise because of the difficulties encountered by staff or a breakdown in communication when residents move from one setting to another (e.g. hospital to nursing home or vice versa).

Development of a core outcome set for effectiveness trials aimed at optimising prescribing in older adults in care homes

“…An age-associated reduction in physiological capacity alongside an increased prevalence of multimorbidity and polypharmacy contribute to the complexities of prescribing in older adults [23]. Prescribing interventions are the most common interventions that take place in care homes and often target inappropriate prescribing (under-, over-, or mis-prescribing), adverse events and compliance [24], and commonly aim to ‘optimise’ the use of medicines.…”

“…Some of the factors contributing to all aspects of poor medicines use in care homes are polypharmacy (care home residents are prescribed an average of eight medicines), inappropriate prescribing, inadequate communication and handover protocols between staff, interruptions during drug rounds, inadequate communication across the various healthcare interfaces’ and the lack of clear responsibility for the review of patients’ medicines [24]. To illustrate further, Loganathan and colleagues’ systematic review [20] of interventions to optimise prescribing in care homes reported heterogeneity in outcomes, hindering the development of firm conclusions and recommendations for practice.…”

Underlying risk factors for prescribing errors in long-term aged care: a qualitative study

“…To reduce preventable harm, safe prescribing in aged care facilities requires consideration of residents’ total needs in order to mitigate cognitive and functional deterioration 1–3. Various studies exploring prescribing safety in long-term aged care facilities report a higher rate of prescribing errors compared with hospitals 7 13 14. Australian long-term aged care facilities also report a high incidence of polypharmacy with residents averaging seven to ten medications each 15 16.…”

Recognition of drug related problems by home healthcare employees: A Dutch observational study with self reports

“…Due to ageing, shorter hospital stays and an emphasis on outpatient care, the number of older persons receiving home healthcare is growing [4] . Therefore, Drug Related Problems (DRPs) are an increasing challenge in homecare organizations as described by Meredith et al [5] and Parsons et al [6] .…”