58 Questions
What was the time period for collecting data on institutionalised elderly and their treatments?
February to July 2021
What was used to report data in the study?
STROBE Statement
What was the age criterion for the study population?
Residents aged 65 years or older
What was excluded from the study?
Over the counter (OTC) medications
How were medications categorised in the study?
According to the WHO ATC classification system
What was used to evaluate the obtained information?
Specific software
How were combination medicines considered in the study?
As a single medicine
What was the classification of polypharmacy status in the study?
Non-polypharmacy (0–4 medicines), polypharmacy (5–9 medicines), excessive polypharmacy (at least 10 medicines)
Which drug group was most frequently implicated in potential adverse drug reactions?
Proton pump inhibitors
What percentage of NH residents used 1–4 drugs that may trigger adverse drug reactions?
45.5%
What is the median number of potential drug-related problems per resident?
10
What is the estimated prevalence of polypharmacy in long-term care facilities according to the WHO?
38.1–91.2%
What percentage of prescriptions of proton pump inhibitors are considered inappropriate?
50%
What is the most commonly detected unnecessary drug in the study?
Omeprazole
What is the recommended action for proton pump inhibitors in the elderly with treatments longer than 8 weeks for uncomplicated disorders?
Discontinue or dose reduce
What is the main challenge associated with polypharmacy?
DDIs and ADRs
What is the percentage of NH residents that had 5 or more potentially inappropriate medications?
53.6%
What is the odds ratio for the risk of potential ADRs when 4–5 pathologies are present?
28.57
What is the primary purpose of the CheckTheMeds program?
To detect anticholinergic risk and drug-related problems
How many residents were selected for the study after screening?
222
What percentage of NH residents had polypharmacy?
78.8%
What is the most common chronic disease in NH residents?
Hypertension
How many drug-related problems (DRPs) were identified in total?
3111
What percentage of NH residents had no DRPs detected?
1.4%
How many duplicities were detected in the study?
23
What percentage of DDIs were classified as severe?
1.8%
What is the most common consequence of DDIs found in the study?
Central nervous system depression
What is the average number of drugs consumed by NH residents with polypharmacy?
7
What percentage of prescriptions of proton pump inhibitors were found to be inappropriate in long-term facilities?
79.7%
What is the maximum daily dose of escitalopram recommended by the FDA and EMA for adults over 65 years?
10 mg
What was the most frequent STOPP criterion found in a study on outpatient elderly?
Duplicity
What percentage of participants in the study were exposed to one or more severe/moderate DDIs?
55.4%
What is the name of the healthcare informatics tool used to screen the treatments of each patient individually?
CheckTheMeds
What is the category of interactions in BOT PLUS that has serious clinical significance?
Major
What is the categorization of DDIs in Drug-Reax?
Major, Moderate, Minor
What is the interaction listed as moderate in BOT PLUS and major in Drug-Reax?
Benzodiazepine + opioid
What is the risk associated with benzodiazepine use in the elderly?
All of the above
What is the percentage of residents with duplicities in their medication?
19.4%
What percentage of residents had duplicities in their medication in this study?
19.4%
What was the most frequent criterion in the STOPP/START criteria applied in a study on outpatient elderly?
Duplicity
What is the maximum daily dose of escitalopram recommended by the FDA and EMA for adults over 65 years?
10 mg
What percentage of DDIs were classified as severe or moderate in this study?
24.7%
What was the most common unnecessary drug found in this study?
Omeprazole
What is the estimated prevalence of polypharmacy in long-term care facilities according to the WHO?
38.1-91.2%
What was the median number of DRPs per resident found in this study?
10
What database was used to detect DDIs in this study, and is widely employed in Spain?
BOT PLUS
What percentage of residents were exposed to one or more severe/moderate DDIs in this study?
55.4%
What tool was used to screen the treatments of each patient individually in this study?
CheckTheMeds
What is the potential risk associated with the combination of omeprazole and gliclazide?
Augmented risk of hypoglycemia
What is the term used to describe the interaction between angiotensin converting enzyme inhibitors/angiotensin-II receptor blockers, diuretic, and nonsteroidal anti-inflammatory drugs?
Triple whammy
What is the estimated prevalence of ADRs in the elderly population?
11-22%
Which of the following medications is metabolized by CYP2C19?
Gliclazide
What is the recommended frequency for reviewing medication in NH residents with polypharmacy?
Every 6 months
What is the primary limitation of the present study?
All of the above
What is the potential consequence of inappropriate polypharmacy in the elderly population?
Increased drug costs
What is the primary goal of identifying DRP in NH residents?
To enhance the quality of life of the elderly population
What is the estimated prevalence of inappropriate medication in the study population?
96.8%
What is the potential benefit of integrating pharmacists into NHs?
Enhanced identification and prevention of DRP
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)
Drug-Related Problems (DRPs)
- 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
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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