Research Study on Institutionalized Elderly in a Nursing Home
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Questions and Answers

What was the time period for collecting data on institutionalised elderly and their treatments?

  • March to June 2021
  • January to December 2021
  • August to November 2021
  • February to July 2021 (correct)

    • What was used to report data in the study?

  • ICD-10
  • WHO ATC classification system
  • CheckTheMeds tool
  • STROBE Statement (correct)

    • What was the age criterion for the study population?

  • Residents aged 70 years or older
  • Residents aged 75 years or older
  • Residents aged 65 years or older (correct)
  • Residents aged 60 years or older

    • What was excluded from the study?

    <p>Over the counter (OTC) medications</p> Signup and view all the answers

    How were medications categorised in the study?

    <p>According to the WHO ATC classification system</p> Signup and view all the answers

    What was used to evaluate the obtained information?

    <p>Specific software</p> Signup and view all the answers

    How were combination medicines considered in the study?

    <p>As a single medicine</p> Signup and view all the answers

    What was the classification of polypharmacy status in the study?

    <p>Non-polypharmacy (0–4 medicines), polypharmacy (5–9 medicines), excessive polypharmacy (at least 10 medicines)</p> Signup and view all the answers

    Which drug group was most frequently implicated in potential adverse drug reactions?

    <p>Proton pump inhibitors</p> Signup and view all the answers

    What percentage of NH residents used 1–4 drugs that may trigger adverse drug reactions?

    <p>45.5%</p> Signup and view all the answers

    What is the median number of potential drug-related problems per resident?

    <p>10</p> Signup and view all the answers

    What is the estimated prevalence of polypharmacy in long-term care facilities according to the WHO?

    <p>38.1–91.2%</p> Signup and view all the answers

    What percentage of prescriptions of proton pump inhibitors are considered inappropriate?

    <p>50%</p> Signup and view all the answers

    What is the most commonly detected unnecessary drug in the study?

    <p>Omeprazole</p> Signup and view all the answers

    What is the recommended action for proton pump inhibitors in the elderly with treatments longer than 8 weeks for uncomplicated disorders?

    <p>Discontinue or dose reduce</p> Signup and view all the answers

    What is the main challenge associated with polypharmacy?

    <p>DDIs and ADRs</p> Signup and view all the answers

    What is the percentage of NH residents that had 5 or more potentially inappropriate medications?

    <p>53.6%</p> Signup and view all the answers

    What is the odds ratio for the risk of potential ADRs when 4–5 pathologies are present?

    <p>28.57</p> Signup and view all the answers

    What is the primary purpose of the CheckTheMeds program?

    <p>To detect anticholinergic risk and drug-related problems</p> Signup and view all the answers

    How many residents were selected for the study after screening?

    <p>222</p> Signup and view all the answers

    What percentage of NH residents had polypharmacy?

    <p>78.8%</p> Signup and view all the answers

    What is the most common chronic disease in NH residents?

    <p>Hypertension</p> Signup and view all the answers

    How many drug-related problems (DRPs) were identified in total?

    <p>3111</p> Signup and view all the answers

    What percentage of NH residents had no DRPs detected?

    <p>1.4%</p> Signup and view all the answers

    How many duplicities were detected in the study?

    <p>23</p> Signup and view all the answers

    What percentage of DDIs were classified as severe?

    <p>1.8%</p> Signup and view all the answers

    What is the most common consequence of DDIs found in the study?

    <p>Central nervous system depression</p> Signup and view all the answers

    What is the average number of drugs consumed by NH residents with polypharmacy?

    <p>7</p> Signup and view all the answers

    What percentage of prescriptions of proton pump inhibitors were found to be inappropriate in long-term facilities?

    <p>79.7%</p> Signup and view all the answers

    What is the maximum daily dose of escitalopram recommended by the FDA and EMA for adults over 65 years?

    <p>10 mg</p> Signup and view all the answers

    What was the most frequent STOPP criterion found in a study on outpatient elderly?

    <p>Duplicity</p> Signup and view all the answers

    What percentage of participants in the study were exposed to one or more severe/moderate DDIs?

    <p>55.4%</p> Signup and view all the answers

    What is the name of the healthcare informatics tool used to screen the treatments of each patient individually?

    <p>CheckTheMeds</p> Signup and view all the answers

    What is the category of interactions in BOT PLUS that has serious clinical significance?

    <p>Major</p> Signup and view all the answers

    What is the categorization of DDIs in Drug-Reax?

    <p>Major, Moderate, Minor</p> Signup and view all the answers

    What is the interaction listed as moderate in BOT PLUS and major in Drug-Reax?

    <p>Benzodiazepine + opioid</p> Signup and view all the answers

    What is the risk associated with benzodiazepine use in the elderly?

    <p>All of the above</p> Signup and view all the answers

    What is the percentage of residents with duplicities in their medication?

    <p>19.4%</p> Signup and view all the answers

    What percentage of residents had duplicities in their medication in this study?

    <p>19.4%</p> Signup and view all the answers

    What was the most frequent criterion in the STOPP/START criteria applied in a study on outpatient elderly?

    <p>Duplicity</p> Signup and view all the answers

    What is the maximum daily dose of escitalopram recommended by the FDA and EMA for adults over 65 years?

    <p>10 mg</p> Signup and view all the answers

    What percentage of DDIs were classified as severe or moderate in this study?

    <p>24.7%</p> Signup and view all the answers

    What was the most common unnecessary drug found in this study?

    <p>Omeprazole</p> Signup and view all the answers

    What is the estimated prevalence of polypharmacy in long-term care facilities according to the WHO?

    <p>38.1-91.2%</p> Signup and view all the answers

    What was the median number of DRPs per resident found in this study?

    <p>10</p> Signup and view all the answers

    What database was used to detect DDIs in this study, and is widely employed in Spain?

    <p>BOT PLUS</p> Signup and view all the answers

    What percentage of residents were exposed to one or more severe/moderate DDIs in this study?

    <p>55.4%</p> Signup and view all the answers

    What tool was used to screen the treatments of each patient individually in this study?

    <p>CheckTheMeds</p> Signup and view all the answers

    What is the potential risk associated with the combination of omeprazole and gliclazide?

    <p>Augmented risk of hypoglycemia</p> Signup and view all the answers

    What is the term used to describe the interaction between angiotensin converting enzyme inhibitors/angiotensin-II receptor blockers, diuretic, and nonsteroidal anti-inflammatory drugs?

    <p>Triple whammy</p> Signup and view all the answers

    What is the estimated prevalence of ADRs in the elderly population?

    <p>11-22%</p> Signup and view all the answers

    Which of the following medications is metabolized by CYP2C19?

    <p>Gliclazide</p> Signup and view all the answers

    What is the recommended frequency for reviewing medication in NH residents with polypharmacy?

    <p>Every 6 months</p> Signup and view all the answers

    What is the primary limitation of the present study?

    <p>All of the above</p> Signup and view all the answers

    What is the potential consequence of inappropriate polypharmacy in the elderly population?

    <p>Increased drug costs</p> Signup and view all the answers

    What is the primary goal of identifying DRP in NH residents?

    <p>To enhance the quality of life of the elderly population</p> Signup and view all the answers

    What is the estimated prevalence of inappropriate medication in the study population?

    <p>96.8%</p> Signup and view all the answers

    What is the potential benefit of integrating pharmacists into NHs?

    <p>Enhanced identification and prevention of DRP</p> Signup and view all the answers

    Study Notes

    Study on Polypharmacy in Nursing Home Residents

    Study Details

    • Observational, descriptive, and cross-sectional study conducted in a nursing home (NH) in León, Spain
    • Data collected from February to July 2021
    • 326 residents were screened for eligibility, and 222 were selected for the study

    Demographics

    • Mean age of participants: 85.5 years (range 65-107, median 86)
    • Women represented the majority (67.1%)
    • All NH residents showed multimorbidity (two or more chronic conditions)

    Chronic Diseases

    • Most common chronic diseases: hypertension (55.5%), cognitive impairment (34.2%), and cataracts (31.5%)

    Polypharmacy

    • Polypharmacy was present in 78.8% of NH residents
    • Total of 1545 drugs consumed, with a median of 7 (range 0-17) drugs per resident
    • Polypharmacy, excessive polypharmacy, and total polypharmacy were associated with:
      • Increasing anticholinergic risk
      • Consumption of two or more unnecessary drugs
      • Severe/moderate drug-drug interactions (DDIs) and potential adverse drug reactions (ADRs)
    • Total of 3111 DRPs identified, with a median of 10 DRPs per resident
    • Only 3 NH residents (1.4%) had no DRPs
    • DRPs included:
      • DDIs (1420)
      • ADRs (684)
      • Potentially inappropriate medications (PIMs) (not detected in only 7 NH residents)

    Drug-Drug Interactions (DDIs)

    • 81.1% of NH residents had at least one DDI
    • Median of 4 DDIs per participant, ranging from 0 to 33
    • DDIs were classified as:
      • Severe (1.8%)
      • Moderate (22.9%)

    Potentially Inappropriate Medications (PIMs)

    • Not detected in only 7 NH residents (3.2%)
    • Median of 5 PIMs per resident
    • PIMs were associated with polypharmacy, except in the group of excessive polypharmacy

    Conclusions

    • High rate of polypharmacy in NH residents
    • Strong correlation between polypharmacy, multimorbidity, and DRPs
    • Importance of evaluating polypharmacy and DRPs in NH residents to improve their quality of life and reduce healthcare costs### Limitations of the Study
    • Small sample size and data from a single nursing home (NH) may affect the generalizability of the results
    • OTCs, dietary supplements, and herbal medications consumed by NH residents were not considered
    • The study was retrospective, with limited information from medical charts and occasional gaps in patient data

    Importance of Integrating Pharmacists in NH Care

    • Interdisciplinary collaboration with doctors and nurses is necessary to identify, solve, and prevent drug-related problems (DRPs)
    • Integration of pharmacists can help define better prevention strategies and enhance the quality of life of NH residents

    Prevalence of Polypharmacy and DRPs in NH Residents

    • High prevalence of polypharmacy and DRPs observed in the NH population
    • Direct correlation between polypharmacy and anticholinergic risk with drug-drug interactions (DDIs) established

    Factors Associated with Polypharmacy

    • Anticholinergic risk and comorbidities are significantly associated with polypharmacy
    • Polypharmacy and anticholinergic risk may trigger adverse drug reactions (ADRs)

    Consequences of DDIs

    • Central nervous system depression and QT prolongation are the most common consequences of DDIs

    Importance of Regular Drug Prescribing Evaluation

    • Regular evaluation of drug prescribing in NH residents is necessary to minimize the risk of DRPs
    • Such evaluation can help clarify diagnoses that do not need pharmacological therapy and distinguish between appropriate and inappropriate polypharmacy

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    Description

    This study examines the treatments and medical information of elderly individuals living in a nursing home in Leon, Spain. Data was collected from medical charts and completed with clinical information from the nursing home's physician.

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