Prevalence of Potentially Inappropriate Medication Use in Older Adults Living in Nursing Homes: A Systematic Review

Morin, Lucas; Laroche, Marie‐Laure; Texier, Géraldine; Johnell, Kristina

doi:10.1016/j.jamda.2016.06.011

Cited by 207 publications

(199 citation statements)

References 83 publications

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“…Our results are consistent with previous studies that have shown high rates of PIM prescribing, particularly antipsychotics, in older nursing home and community‐dwelling populations . A study of older adults in dementia care units found that 37.5% were prescribed an antipsychotic and 18.5% received anticholinergic drugs .…”

Section: Discussionsupporting

confidence: 92%

Frailty and Potentially Inappropriate Medication Use at Nursing Home Transition

Maclagan

Maxwell

Gandhi

et al. 2017

J American Geriatrics Society

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Section: Discussionsupporting

confidence: 92%

Frailty and Potentially Inappropriate Medication Use at Nursing Home Transition

Maclagan

Maxwell

Gandhi

et al. 2017

J American Geriatrics Society

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“…Six of the 10 American Geriatrics Society's ‘Things Patients and Providers Should Question’ from the Choosing Wisely Initiative caution against use of specific medications known to be overused in older adults. There are several published systematic reviews on quantification of PIM use, but few have focused on synthesizing the determinants of PIM use. Without knowing what drives the use of potentially harmful medications, it will be challenging to target interventions towards specific factors to reduce this practice.…”

Section: Introductionmentioning

confidence: 99%

Factors associated with potentially inappropriate medication use in community-dwelling older adults in the United States: a systematic review†

Nothelle

Sharma

Oakes

et al. 2019

International Journal of Pharmacy Practice

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Objectives Potentially inappropriate medication (PIM) use in older adults is a prevalent problem associated with poor health outcomes. Understanding drivers of PIM use is essential for targeting interventions. This study systematically reviews the literature about the patient, clinician and environmental/system factors associated with PIM use in community‐dwelling older adults in the United States. Methods PRISMA guidelines were followed when completing this review. PubMed and EMBASE were queried from January 2006 to September 2017. Our search was limited to English‐language studies conducted in the United States that assessed factors associated with PIM use in adults ≥65 years who were community‐dwelling. Two independent reviewers screened titles and abstracts. Reviewers abstracted data sequentially and assessed risk of bias independently. Key findings Twenty‐two studies were included. Nineteen examined patient factors associated with PIM use. The most common statistically significant factors associated with PIM use were taking more medications, female sex, and higher outpatient and emergency department utilization. Only three studies examined clinician factors, and few were statistically significant. Fifteen studies examined system‐level factors such as geographic region and health insurance. The most common statistically significant association was the south and west geographic region relative to the northeast United States. Conclusions Amongst older adults, women and persons on more medications are at higher risk of PIM use. There is evidence that increased healthcare use is also associated with PIM use. Future studies are needed exploring clinician factors, such as specialty, and their association with PIM prescribing.

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“…22 In studies published in 2014 and 2015, the prevalence of at least 1 PIM ranged from 51.4% to 70.6% of NH residents. 22 Also, although opioid use is decreasing in outpatients, opioids are still commonly part of postsurgical rehabilitation pain management, and older veterans are admitted to CLCs for rehabilitation. Therefore, we believe our results remain applicable in a sizable proportion of this population.…”

Section: Discussionmentioning

confidence: 97%

“…Finally, there is the question of generalizability because the data used in this study are older and may not reflect current prescribing practices if CNS medication use has decreased (fewer individuals with a CNS medication burden of ≥3.0) as a result of newer guidelines such as the Beers and STOPP criteria, although a systematic review from 2016 assessed potentially inappropriate medications (PIMs) in NH residents (a majority of which are CNS drugs) and found an increase in the proportion receiving PIMs in studies published after 2005 (49.8%) than in those from 1990 to 1999 (30.3%) . In studies published in 2014 and 2015, the prevalence of at least 1 PIM ranged from 51.4% to 70.6% of NH residents . Also, although opioid use is decreasing in outpatients, opioids are still commonly part of postsurgical rehabilitation pain management, and older veterans are admitted to CLCs for rehabilitation.…”

Section: Discussionmentioning

confidence: 99%

Central Nervous System Medication Burden and Risk of Recurrent Serious Falls and Hip Fractures in Veterans Affairs Nursing Home Residents

Aspinall

Springer

Zhao

et al. 2018

J American Geriatrics Society

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Objectives To examine the association between central nervous system (CNS) medication dosage burden and risk of serious falls, including hip fractures, in individuals with a history of a recent fall. Design Nested case–control study. Setting Veterans Health Administration (VHA) Community Living Centers (CLCs). Participants CLC residents aged 65 and older with a history of a fall or hip fracture in the year before a CLC admission between July 1, 2005, and June 30, 2009. Each case (n = 316) was matched to four controls (n = 1264) on age, sex, and length of stay. Measurements Outcomes were serious falls identified using International Classification of Diseases, Ninth Revision (ACD‐9) or Current Procedural Terminology (CPT) E codes, diagnosis codes, or procedure codes associated with a VHA emergency department visit or hospitalization during the CLC stay. Bar code medication administration data were used to calculate CNS standardized daily doses (SDDs) for opioid and benzodiazepine receptor agonists, some antidepressants, antiepileptics, and antipsychotics received in the 6 days before the outcome date by dividing residents' actual CNS daily doses by the minimum effective geriatric daily doses and adding the results. Multivariable conditional logistic regression models were used to evaluate the association between total CNS medication dosage burden, categorized as 0, 1 to 2, and 3 or more SDDs, and the outcome of recurrent serious falls. Results More cases (44.3%) than controls (35.8%) received 3.0 or more CNS SDDs (p = .02). Risk of serious falls was greater in residents with 3.0 or more SDDs than in those with 0 (adjusted odds ratio (aOR)=1.49, 95% confidence interval (CI)=1.03–2.14). Those with 1.0 to 2.9 SDDs had a risk similar to that of those with 0 SDDs (aOR=1.03, 95%CI=0.72–1.48). Conclusion Nursing home residents with a history of a fall or hip fracture receiving 3.0 or more CNS SDDs were more likely to have a recurrent serious fall than those taking no CNS medications. Interventions targeting this vulnerable population may help reduce serious falls. J Am Geriatr Soc 67:74–80, 2019.

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Prevalence of Potentially Inappropriate Medication Use in Older Adults Living in Nursing Homes: A Systematic Review

Abstract: This systematic review shows that almost one-half of nursing home residents are exposed to potentially inappropriate medications and suggests an increase prevalence over time. Effective interventions to optimize drug prescribing in nursing home facilities are, therefore, needed.

Cited by 207 publications

References 83 publications

Frailty and Potentially Inappropriate Medication Use at Nursing Home Transition

Frailty and Potentially Inappropriate Medication Use at Nursing Home Transition

Factors associated with potentially inappropriate medication use in community-dwelling older adults in the United States: a systematic review†

Central Nervous System Medication Burden and Risk of Recurrent Serious Falls and Hip Fractures in Veterans Affairs Nursing Home Residents

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