PRN Medicines Management for Older People with Long-Term Mental Health Disorders in Home Care

Abstract

Older people with long-term mental health conditions who receive care in their own home are vulnerable to the inappropriate use of medications and polypharmacy given their underlying health conditions and comorbidities. Inappropriate use of pro re nata (PRN) medications in these older people can enhance their suffering and have negative consequences for their quality of life and well-being, leading to readmission to healthcare settings and the increased cost of health care. This narrative review on published international literature aims at improving our understanding of medicines management in home care and how to improve PRN medication use among older people with long-term health conditions in their own home. Accordingly, the improvement of PRN medicines management for these older people requires the development of an individualised care plan considering 'reduction of older people's dependence on PRN medications', 'empowerment of family caregivers', and 'support by healthcare professionals.' PRN medication use should be reduced through deprescription and discontinuation strategies. Also, older people and their family caregivers should be encouraged to prioritize the use of non-pharmacologic methods to relieve physical and psychological problems. Besides the empowerment of family caregivers through role development, education and training about PRN medications, and involvement in decision-making, they need support by the multidisciplinary network in terms of supervision, monitoring, and home visits.

Practical Considerations of PRN Medicines Management: An Integrative Systematic Review

“…Our review findings highlighted the deprescription of PRN medications and its replacement with non-pharmacologic methods to prevent polypharmacy and medication abuse. The plan for deprescribing process of PRN medications should be devised based on each patient’s need and under close monitoring ( Renn et al, 2018 ; Vaismoradi et al, 2021a ). Also, cost and benefit assessment with regard to the continuation and discontinuation of medications should be performed ( Renn et al, 2018 ).…”

“…Also, cost and benefit assessment with regard to the continuation and discontinuation of medications should be performed ( Renn et al, 2018 ). Moreover, the concerns of patients and their informal caregivers about the replacement of medications by alternative therapies that can influence their collaboration with the deprescription plan should be taken seriously ( Scott et al, 2015 ; Vaismoradi et al, 2021a ). Given that the use of PRN medications reduce the inclusion of other therapeutic interventions in the therapeutic plan ( Hipp et al, 2018 ), PRN medications should not be used when potential non-pharmacological treatment options are available ( Martin et al, 2017 ).…”

“…Due to the highly widespread use of PRN medications in various healthcare settings, and the growing concern regarding the use of PRN medications as the first-line choice for relieving patient’s suffering, there is a need for the introduction of evidenced-based protocols and procedures with regard to prescription, dispensing, administration, and monitoring of PRN medications. Also, reviews on PRN medications in terms of indication, frequency, and interdisciplinary collaborations for PRN medicines management is insufficient ( Martin et al, 2017 ; Vaismoradi et al, 2021a ). Therefore, this study aimed to summarize and integrate the findings of all relevant individual studies regarding the practical considerations of PRN medicines management including strategies and interventions by healthcare professionals for prescription, dispensing, administration, monitoring, and deprescription of PRN medicines in healthcare settings.…”

Needs Assessment of Safe Medicines Management for Older People With Cognitive Disorders in Home Care: An Integrative Systematic Review

“…The accepted perspective is that older people with cognitive impairment living in the community need coordinated and flexible care process (60)(61)(62)). An early integration of holistic palliative care approaches that encompass medicines management initiatives into home care should be included from the beginning of the illness (63,64). The Lancet's call for action specifies "as the world population ages, comorbidity also increases, a shift from a health system centred in medical specialties to person-centred care is required."…”

Ethical Tenets of PRN Medicines Management in Healthcare Settings: A Clinical Perspective

“…PRN medicines management starts with the patient’s verbal request for medications aiming at relieving his/her physical and/or mental suffering. The observation of the patient’s clinical sign and behavioural clues also can help the nurse identify his/her need for PRN medications [ 27 ].…”