Skip to main content
SpringerLink
Log in

Medication Management in Long-Term Care

  • Chapter
  • First Online:
Long-Term Care Medicine

Part of the book series: Current Clinical Practice ((CCP))

  • 938 Accesses

Abstract

Most clinicians recognize that the elderly take a disproportionately large number of medications compared to younger people and, as a result, they are two to three times more likely to experience adverse drug events (ADEs) [1]. Since pharmacologic therapy for chronic disease treatment is an essential component of the care of geriatric patients, optimization of their drug regimen is an important public health issue in the United States. The geriatric population is the fastest growing segment in the United States in that by 2030, 20% of the US population will be 65 or older. Appropriate prescribing, especially for frail residents of long-term care facilities (LTCF), is challenging due to multiple chronic diseases, limited physiologic reserves, changes in pharmacokinetics and pharmocodynamics, and impaired immune and inflammatory mechanisms. The physical disabilities of these frail elders can be significant. According to the Agency for Healthcare Research and Quality, 83% of nursing home residents receive assistance with three or more activities of daily living (ADL) that include bathing, dressing, toileting, transferring from bed or chair, feeding, and walking. Therefore, these frail elders with their disabilities are highly susceptible to the serious consequences of ADEs, such as hip fractures, weight loss, cognitive, and functional decline. As 27% of LTCF patients take 9 or more prescription medications daily, it should not be surprising that over 65% have ADEs over a 4-year period, while 1 in 7 of these ADEs results in a hospital transfer [2]. Therefore, the prevention and recognition of medication-related problems in patients is a principal healthcare quality and safety issue for LTC facilities, hospitals, and the ambulatory care settings.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 59.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Nolan L, O’Malley K. Prescribing for the elderly. Part I: Sensitivity of the elderly to adverse drug reactions. J Am Geriatr Soc 1988;36:142.

    PubMed  CAS  Google Scholar 

  2. Cooper JW. Probable adverse drug reactions in a rural geriatric nursing home population: a four-year study. J Am Geriatr Soc 1996;44: 194–197.

    PubMed  CAS  Google Scholar 

  3. Briesacher B, Limcangco R, Simoni-Wastila L, et al. Evaluation of nationally mandated drug use reviews to improve patient safety in nursing homes: a natural experiment. J Am Geriatr Soc 2005;53: 991–996.

    Article  PubMed  Google Scholar 

  4. Oates JA, Wilkinson GR. Chapter 68: Principles of Drug Therapy. In: Fauci AS, Braunwald E, Isselbacher, KJ, et al (eds). Harrison’s Principles of Internal Medicine 14th Ed. volume 1 New York: McGraw-Hill, 1998;411–424.

    Google Scholar 

  5. McLean AJ, Le Conteur DG. Aging biology and geriatric clinical pharmacology. Pharmacol Rev 2004;56:163–184.

    Article  PubMed  CAS  Google Scholar 

  6. Roskos KV, Maibach HI, Guy RH. The effect of aging on percutaneous absorption in man. J Pharmacokinet Biopharm 1989;17:617–630.

    Article  PubMed  CAS  Google Scholar 

  7. Parker BM, Cusack BJ, Vestal RE. Pharmacokinetic optimization of drug therapy in elderly patients. Drugs Aging 1995;7:10–18.

    Article  PubMed  Google Scholar 

  8. Greenblatt DJ, Sellers EM, Shader RI. Drug disposition in old age. NEJM 1982; 306: 1081–1087.

    Article  PubMed  CAS  Google Scholar 

  9. Todd PA, Fitton A. Perindopril. A review of its pharmacological properties and therapeutic use. Drugs 1991;42:90–114.

    Article  PubMed  CAS  Google Scholar 

  10. Bennett WM. Geriatric pharmacokinetics and the kidney. Am J Kidney Dis 1990;16:283.

    PubMed  CAS  Google Scholar 

  11. Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron 1976;16:31–41.

    Article  PubMed  CAS  Google Scholar 

  12. GFR Calculator Using Cockcroft-Gault, MDRD equations. http://nephron.org/cgi_bln/MDRD_GFR/cgi. Accessed on November 9, 2009.

  13. Garg AX, Papaioannou A, Ferko N, et al. Estimating the prevalence of renal insufficiency in long-term care. Kidney Int 2004;65(2):649–653.

    Article  PubMed  Google Scholar 

  14. Beers MH. Explicit criteria for determining potentially inappropriate medication use by the elderly. Arch Intern Med 2001;135:703.

    Google Scholar 

  15. Fick DM, Cooper JW, Wade WE, Waller JL, MacLean JR, Beers MH. Updating the Beers criteria for potentially inappropriate medication use in older adults: Results of a US consensus panel of experts. Arch Intern Med 2003;163:2716–2724.

    Article  PubMed  Google Scholar 

  16. Gallagher P, Ryan C, Byrne S. STOPP(Screening Tool of Older Person’s Prescriptions) and START (Screening Tool to Alert Doctors to Right Treatment). Consensus Validation. Int J Clin Pharmacol Ther 2008; 46(2):72–83.

    PubMed  CAS  Google Scholar 

  17. Maixner SM, Mellow AM, Tandon R. The efficacy, safety, and tolerability of antipsychotics in the elderly. J Clin Psychiatry 1999; 60(Suppl 8):29–41.

    PubMed  Google Scholar 

  18. Warning of Fatal Reactions in Geriatrics Patients of Typical and Atypical Antipsychotics. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2008/ucm116912.htm. Accessed on November 1, 2009.

  19. Gerstein HC, Miller ME, Byington RP, et al. Action to Control Cardiovascular Risk in Diabetes Study Group. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med 2008;358:2560–2572.

    Article  Google Scholar 

  20. Duckworth W, Abraira C, Moritz T, et al. VADT Investigators. Glucose control and vascular complications n veterans with type 2 diabetes. N Engl J Med 2009;360:129–139.

    Article  PubMed  CAS  Google Scholar 

  21. Home PD, Pocock SJ, Beck-Nielsen H, et al. Rosiglitazone Evaluated for Cardiac Outcomes in oral agent combinations therapy for type 2 diabetes mellitus (RECORD): a multicenter, randomized, open-label trial. Lancet 2009; 373(9681): 2125–2135.

    Article  PubMed  CAS  Google Scholar 

  22. AGS Clinical Practice Guidelines for Pharmacological Management of Persistent Pain in Older Persons. http://www.americangeriatrics.org/education/pharm_management.shtml. Accessed on November 5, 2009.

  23. McGettigan P, Henry D. Cardiovascular risk and inhibitors of cycloxoygenase: a systemic review of observational studies of selective and non-selective inhibitors of cyclooxygenase-2. JAMA 2006;296(13): 1633–1644.

    Article  PubMed  CAS  Google Scholar 

  24. Kuehn J. FDA Focuses on drugs and liver damage: labeling and other changes for acetaminophen. JAMA 2009;302:369–371.

    Article  PubMed  CAS  Google Scholar 

  25. US Food and Drug Administration Medication Guides. http://www.fda.gov/Drugs/DrugSafety/ucm085729.htm. Accessed on December 10, 2009.

  26. Higashi T, Shekelle PG, Adams JL, et al. The quality of pharmacologic care for vulnerable older patients. Ann Intern Med 2004;140:714–720.

    PubMed  Google Scholar 

  27. Hollander M, Koudstaal PJ, Bots ML, etal. Incidence, risk and case fatality of first ever stroke in the elderly population: the Rotterdam Study. J Neurol Neurosurg Psychiatry 2003;74:317–321.

    Article  PubMed  CAS  Google Scholar 

  28. Bulpitt C, Fletcher A, Beckett N. Hypertension in the very elderly trial (HyVET). Drugs Aging 2001;18(3):151–164.

    Article  PubMed  CAS  Google Scholar 

  29. Oates DJ, Berlowitz DR, Glickman ME, et al. Blood pressure and survival in the oldest old. J Am Geriatr Soc 2007;55:383–388.

    Article  PubMed  Google Scholar 

  30. Sacks FM, Svetkey LP, Vollmer WM, et al. Effects on blood pressure of reduced dietary sodium and the dietary approaches to stop hypertension (DASH)diet. N Engl J Med 2001;344:3–10.

    Article  PubMed  CAS  Google Scholar 

  31. Your Guide to Lowering Your Blood Pressure with DASH. The DASH Eating Plan. Available on http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf. Accessed on December 11.

  32. Chobanian AV, Bakris GL, Black HR. Seventh report of the Joint National Committee(JNC) on the prevention, detection, evaluation and therapy of high blood pressure. Hypertension 2003;42:1206–1252.

    Article  PubMed  CAS  Google Scholar 

  33. Soumerai SB, McLaughlin TJ, Spiegelman D, et al. Adverse outcomes of underuse of beta-blockers in elderly survivors of acute myocardial infarction. JAMA 1997;277(2):115–121.

    Article  PubMed  CAS  Google Scholar 

  34. MD + CALC. CHADS2 Score for Atrial Fibrillation Stroke Risk. http://www.mdcalc.com/chads2-score-for-atrial-fibrillation-stroke-risk. Accessed December 3, 2009.

  35. Dhond AJ, Michaelena HI, Ezekowitz MD. Anticoagulation in the elderly. Am J Geriatr Cardiol 2003;12(4):243–250.

    Article  PubMed  Google Scholar 

  36. Hollowell JG; Staehling NW, Flanders WD, et al. Serum TSH T4 and thyroid antibodies in the United States population (1988-94): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab 2002;87:489–499.

    Article  PubMed  CAS  Google Scholar 

  37. Samuels MH, Schuff KG, Carlson NE, et al. Health status, mood and cognition in experimentally induced subclinical hypothyroidism. J Clin Endocrinol Metab 2007;92:2545–2551.

    Google Scholar 

  38. Bolk N, Visser TJ, Kalsbeek A, et al. Effects of evening vs morning thyroxine ingestion on serum thyroid hormone profiles in hypothyroid patients. Clin Endocrinol (Oxf) 2007;66:43–48.

    CAS  Google Scholar 

  39. Clinical Practice Guidelines of the American Association of Clinical Endocrinologists for management of patients with hypothyroidism and suspected hypothyroidism. 2006 Updates www.aace.com/pub/pdf/guidelines/hypo_hyper.pdf Accessed on December 15, 2009.

Download references

Author information

Authors and Affiliations

  1. Geriatrician for Overlake Medical Clinics, Downtown Bellevue, 400 108th Avenue, Suite 100, Bellevue, WA, 98004, USA

    Susan T. Marcolina

  2. Department of Pharmacy: Clinical and Administrative Sciences, University of Oklahoma Health Sciences Center, 26901, 1110 N. Stonewall, College of Pharmacy, Oklahoma City, OK, 73126-0901, USA

    Keith Swanson

Authors
  1. Susan T. Marcolina
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Keith Swanson
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Abington Memorial Hospital, Old York Road 500, Jenkintown, 19046, Pennsylvania, USA

    Pamela Ann Fenstemacher

  2. Dept. Family & Preventive Medicine, University of Oklahoma, NE. 10th St. 900, Oklahoma City, 73104, Oklahoma, USA

    Peter Winn

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Marcolina, S.T., Swanson, K. (2011). Medication Management in Long-Term Care. In: Fenstemacher, P., Winn, P. (eds) Long-Term Care Medicine. Current Clinical Practice. Humana Press. https://doi.org/10.1007/978-1-60761-142-4_15

Download citation

  • DOI: https://doi.org/10.1007/978-1-60761-142-4_15

  • Published:

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-60761-141-7

  • Online ISBN: 978-1-60761-142-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation