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Balancing medication use in nursing home residents with life-limiting disease

  • Pharmacoepidemiology and Prescription
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Abstract

Purpose

Balancing medications that are needed and beneficial and avoiding medications that may be harmful is important to prevent drug-related problems, and improve quality of life. The aim of this study is to describe medication use, the prevalence of deprescribing of medications suitable for deprescribing, and the prevalence of new initiation of potentially inappropriate medications (PIMs) in nursing home (NH) residents with life-limiting disease in Flanders.

Methods

NH residents aged ≥ 65, suffering from end stage organ failure, advanced cancer, and/or dementia (n = 296), were included in this cross-sectional study with retrospective analyses of medication use at the time of data collection (t2) and 3 to 6 months before (t1). The appraisal of appropriateness of medications was done using a list of medications documented as suitable for deprescribing, and STOPPFrail criteria.

Results

Residents’ (mean age 86 years, 74% female) mean number of chronic medications increased from 7.4 (t1) to 7.9 (t2). In 31% of those using medications suitable for deprescribing, at least one medication was actually deprescribed. In 30% at least one PIM from the group of selected PIMs was newly initiated. In the subgroup (n = 76) for whom deprescribing was observed, deprescribing was associated with less new initiations of PIMs (r = − 0.234, p = 0.042).

Conclusion

Medication use remained high at the end of life for NH residents with life-limiting disease, and deprescribing was limited. However, in the subgroup of 76 residents for whom deprescribing was observed, less new PIMs were initiated.

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Acknowledgements

The authors thank Elke Dewulf and Alizée Vercruysse (master students Antwerp University) for the data collection.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Author notes

  1. Thierry Christiaens and Tinne Dilles contributed equally as last author

Authors and Affiliations

  1. End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Laarbeeklaan 103, 1090, Brussels, Belgium

    Kristel Paque, Koen Pardon & Luc Deliens

  2. Clinical Pharmacology Research Unit, Heymans Institute of Pharmacology, Ghent University, C. Heymanslaan 10, 9000, Ghent, Belgium

    Kristel Paque, Monique Elseviers, Robert Vander Stichele & Thierry Christiaens

  3. Faculty of Medicine and Health Sciences, Department of Nursing Science, Centre for Research and Innovation in Care (NuPhaC), University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium

    Monique Elseviers, Cinzia Vinkeroye & Tinne Dilles

  4. Department of Public Health and Primary Care, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium

    Luc Deliens

Authors
  1. Kristel Paque
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  2. Monique Elseviers
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Contributions

Study design: Kristel Paque, Monique Elseviers, Robert Vander Stichele, Koen Pardon, Cinzia Vinkeroye, Luc Deliens, Thierry Christiaens, and Tinne Dilles.

Study protocol: Kristel Paque, Monique Elseviers, and Tinne Dilles with input from other authors.

Research: Kristel Paque, Cinzia Vinkeroye, Monique Elseviers, and Tinne Dilles.

Data analyses: Kristel Paque and Cinzia Vinkeroye.

First and other drafts: Kristel Paque wrote the first draft of this article, which was discussed at two meetings with the team of authors. Kristel Paque redrafted the article, taking the feedback and input of all co-authors into account.

Corresponding author

Correspondence to Kristel Paque.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Paque, K., Elseviers, M., Vander Stichele, R. et al. Balancing medication use in nursing home residents with life-limiting disease. Eur J Clin Pharmacol 75, 969–977 (2019). https://doi.org/10.1007/s00228-019-02649-6

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  • DOI: https://doi.org/10.1007/s00228-019-02649-6

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