Skip to main content
SpringerLink
Log in

Use and Deprescribing of Potentially Inappropriate Medications in Frail Nursing Home Residents

  • Original Research Article
  • Published:
Drugs & Aging Aims and scope Submit manuscript

Abstract

Background

The STOPPFrail criteria were developed to assist physicians in deprescribing medications among frail patients approaching end of life. We aimed to measure the prevalence of potentially inappropriate medications (PIMs) and to describe changes over time, using STOPPFrail, in frail nursing home residents (NHRs) with limited life expectancy included in a medication review trial.

Methods

We conducted a post-hoc analysis of the COME-ON study, a cluster-controlled trial that evaluated the effect of a complex intervention on appropriateness of prescribing in Belgian nursing homes. We identified NHRs eligible for the application of STOPPFrail based on functional status, comorbidities, level of care and survival. PIM use was measured at baseline and at 8 months. Changes over time were compared in the control group (CG) and intervention group (IG).

Results

At baseline, 308 NHRs met the STOPPFrail eligibility criteria, of whom 196 (64.1%) had one or more PIM. At 8 months, among the 218 NHRs who were alive, there was an absolute reduction in the prevalence of PIMs of 9.1% in the CG (p < 0.05) and 10.2% in the IG (p < 0.05). We found large reductions for some medications (e.g. proton pump inhibitors) but no reduction for others (e.g. calcium). The percentage of NHRs with one or more PIM discontinued without a new PIM initiated was higher in the IG than the CG but the difference was not significant (35.1% vs 23.6%, p = 0.127).

Conclusion

Among frail NHRs with poor survival prognosis, a significant and encouraging decrease in PIM prevalence over time was observed, probably facilitated by medication reviews. The overall prevalence of PIMs remained high, however.

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

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Jokanovic N, Tan EC, Dooley MJ, Kirkpatrick CM, Bell JS. Prevalence and factors associated with polypharmacy in long-term care facilities: a systematic review. J Am Med Dir Assoc. 2015;16(6):535 e1-12. https://doi.org/10.1016/j.jamda.2015.03.003.

    Article  PubMed  Google Scholar 

  2. Morin L, Laroche ML, Texier G, Johnell K. Prevalence of potentially inappropriate medication use in older adults living in nursing homes: a systematic review. J Am Med Dir Assoc. 2016;17(9):862 e1-9. https://doi.org/10.1016/j.jamda.2016.06.011.

    Article  PubMed  Google Scholar 

  3. Jano E, Aparasu RR. Healthcare outcomes associated with beers' criteria: a systematic review. Ann Pharmacother. 2007;41(3):438–47. https://doi.org/10.1345/aph.1H473.

    Article  PubMed  Google Scholar 

  4. Perri M 3rd, Menon AM, Deshpande AD, Shinde SB, Jiang R, Cooper JW, et al. Adverse outcomes associated with inappropriate drug use in nursing homes. Ann Pharmacother. 2005;39(3):405–11. https://doi.org/10.1345/aph.1E230.

    Article  PubMed  Google Scholar 

  5. Lau DT, Kasper JD, Potter DE, Lyles A, Bennett RG. Hospitalization and death associated with potentially inappropriate medication prescriptions among elderly nursing home residents. Arch Intern Med. 2005;165(1):68–74. https://doi.org/10.1001/archinte.165.1.68.

    Article  PubMed  Google Scholar 

  6. Albert SM, Colombi A, Hanlon J. Potentially inappropriate medications and risk of hospitalization in retirees: analysis of a US retiree health claims database. Drugs Aging. 2010;27(5):407–15. https://doi.org/10.2165/11315990-000000000-00000.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Klarin I, Wimo A, Fastbom J. The association of inappropriate drug use with hospitalisation and mortality: a population-based study of the very old. Drugs Aging. 2005;22(1):69–82.

    Article  Google Scholar 

  8. Dalleur O, Spinewine A, Henrard S, Losseau C, Speybroeck N, Boland B. Inappropriate prescribing and related hospital admissions in frail older persons according to the STOPP and START criteria. Drugs Aging. 2012;29(10):829–37.

    Article  Google Scholar 

  9. Ruggiero C, Dell'Aquila G, Gasperini B, Onder G, Lattanzio F, Volpato S, et al. Potentially inappropriate drug prescriptions and risk of hospitalization among older, Italian, nursing home residents: the ULISSE project. Drugs Aging. 2010;27(9):747–58. https://doi.org/10.2165/11538240-000000000-00000.

    Article  PubMed  Google Scholar 

  10. Bo M, Quaranta V, Fonte G, Falcone Y, Carignano G, Cappa G. Prevalence, predictors and clinical impact of potentially inappropriate prescriptions in hospital-discharged older patients: a prospective study. Geriatr Gerontol Int. 2018;18(4):561–8. https://doi.org/10.1111/ggi.13216.

    Article  PubMed  Google Scholar 

  11. O'Mahony D, O'Sullivan D, Byrne S, O'Connor MN, Ryan C, Gallagher P. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing. 2015;44(2):213–8. https://doi.org/10.1093/ageing/afu145.

    Article  PubMed  Google Scholar 

  12. By the American Geriatrics Society Beers Criteria Update Expert P. American Geriatrics Society 2015 updated beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2015;63(11):2227–46. https://doi.org/10.1111/jgs.13702.

  13. Khodyakov D, Ochoa A, Olivieri-Mui BL, Bouwmeester C, Zarowitz BJ, Patel M, et al. Screening tool of older person's prescriptions/screening tools to alert doctors to right treatment medication criteria modified for U.S. Nursing Home Setting. J Am Geriatr Soc. 2017;65(3):586–91. https://doi.org/10.1111/jgs.14689.

    Article  PubMed  Google Scholar 

  14. Nyborg G, Straand J, Klovning A, Brekke M. The Norwegian General Practice-Nursing Home criteria (NORGEP-NH) for potentially inappropriate medication use: a web-based Delphi study. Scand J Prim Health Care. 2015;33(2):134–41. https://doi.org/10.3109/02813432.2015.1041833.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Lavan AH, Gallagher P, Parsons C, O'Mahony D. STOPPFrail (Screening Tool of Older Persons Prescriptions in Frail adults with limited life expectancy): consensus validation. Age Ageing. 2017;46(4):600–7. https://doi.org/10.1093/ageing/afx005.

    Article  PubMed  Google Scholar 

  16. Curtin D, O'Mahony D, Gallagher P. Drug consumption and futile medication prescribing in the last year of life: an observational study. Age Ageing. 2018. https://doi.org/10.1093/ageing/afy054.

    Article  PubMed  Google Scholar 

  17. Paque K, De Schreye R, Elseviers M, Vander Stichele R, Pardon K, Dilles T, et al. Discontinuation of medications at the end of life: a population study in Belgium, based on linked administrative databases. Br J Clin Pharmacol. 2019;85(4):827–37. https://doi.org/10.1111/bcp.13874.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Lavan AH, O'Mahony D, Gallagher P. STOPPFrail (Screening Tool of Older Persons' Prescriptions in Frail adults with a limited life expectancy) criteria: application to a representative population awaiting long-term nursing care. Eur J Clin Pharmacol. 2019;75(5):723–31. https://doi.org/10.1007/s00228-019-02630-3.

    Article  PubMed  Google Scholar 

  19. Paque K, Elseviers M, Vander Stichele R, Pardon K, Vinkeroye C, Deliens L, et al. Balancing medication use in nursing home residents with life-limiting disease. Eur J Clin Pharmacol. 2019;75(7):969–77. https://doi.org/10.1007/s00228-019-02649-6.

    Article  PubMed  Google Scholar 

  20. Paque K, Elseviers M, Vander Stichele R, Dilles T, Pardon K, Deliens L, et al. Associations of potentially inappropriate medication use with four year survival of an inception cohort of nursing home residents. Arch Gerontol Geriatr. 2019;80:82–7. https://doi.org/10.1016/j.archger.2018.10.011.

    Article  PubMed  Google Scholar 

  21. Anrys P, Strauven G, Boland B, Dalleur O, Declercq A, Degryse JM, et al. Collaborative approach to Optimise MEdication use for Older people in Nursing homes (COME-ON): study protocol of a cluster controlled trial. Implement Sci. 2016;11:35. https://doi.org/10.1186/s13012-016-0394-6.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Anrys PMS, Strauven GC, Foulon V, Degryse JM, Henrard S, Spinewine A. Potentially inappropriate prescribing in Belgian nursing homes: prevalence and associated factors. J Am Med Dir Assoc. 2018. https://doi.org/10.1016/j.jamda.2018.06.010.

    Article  PubMed  Google Scholar 

  23. Strauven G, Anrys P, Vandael E, Henrard S, De Lepeleire J, Spinewine A, et al. Cluster-controlled trial of an intervention to improve prescribing in nursing homes study. J Am Med Dir Assoc. 2019;20(11):1404–11. https://doi.org/10.1016/j.jamda.2019.06.006.

    Article  PubMed  Google Scholar 

  24. Miller MD, Paradis CF, Houck PR, Mazumdar S, Stack JA, Rifai AH, et al. Rating chronic medical illness burden in geropsychiatric practice and research: application of the Cumulative Illness Rating Scale. Psychiatry Res. 1992;41(3):237–48. https://doi.org/10.1016/0165-1781(92)90005-n.

    Article  CAS  PubMed  Google Scholar 

  25. Anrys P, Boland B, Degryse JM, De Lepeleire J, Petrovic M, Marien S, et al. STOPP/START version 2-development of software applications: easier said than done? Age Ageing. 2016;45(5):589–92. https://doi.org/10.1093/ageing/afw114.

    Article  PubMed  Google Scholar 

  26. R Core Team. R: a language and environnment for statistical computing. Austria: R Foundation for Statistical Computing V; 2016. https://www.R-project.org/.

  27. Curtin D, Jennings E, Daunt R, Curtin S, Randles M, Gallagher P, et al. Deprescribing in older people approaching end of life: a randomized controlled trial using STOPPFrail criteria. J Am Geriatr Soc. 2020;68(4):762–9. https://doi.org/10.1111/jgs.16278.

    Article  PubMed  Google Scholar 

  28. Beuscart JB, Knol W, Cullinan S, Schneider C, Dalleur O, Boland B, et al. International core outcome set for clinical trials of medication review in multi-morbid older patients with polypharmacy. BMC Med. 2018;16(1):21. https://doi.org/10.1186/s12916-018-1007-9.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Louvain Drug Research Institute, Clinical Pharmacy Research Group, Université Catholique de Louvain, Avenue Mounier 72/B1.72.02, 1200 Woluwe-Saint-Lambert, Brussels, Belgium

    Anne Fournier, Pauline Anrys, Olivia Dalleur, Séverine Henrard & Anne Spinewine

  2. Cliniques Universitaires Saint-Luc, Pharmacy Department, Université Catholique de Louvain, Brussels, Belgium

    Anne Fournier & Olivia Dalleur

  3. Univ. Lille, CHU Lille, ULR 2694 - METRICS : Évaluation des technologies de santé et des pratiques médicales, 59000, Lille, France

    Jean-Baptiste Beuscart

  4. Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium

    Séverine Henrard

  5. Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium

    Veerle Foulon

  6. CHU UCL Namur, Pharmacy Department, Université Catholique de Louvain, Yvoir, Belgium

    Anne Spinewine

Authors
  1. Anne Fournier
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Pauline Anrys
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jean-Baptiste Beuscart
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Olivia Dalleur
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Séverine Henrard
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Veerle Foulon
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Anne Spinewine
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anne Spinewine.

Ethics declarations

Author contributions

AF, AS, JBB and PA designed the study. AF, AS, PA, JBB, OD and SH analysed the data. AF, PA, OD, AS, VF and JBB wrote the manuscript. All authors contributed to and approved the final version of the manuscript.

Funding

No specific funding has been received for this work. The original COME-ON study was funded by the National Institute for Health and Disability Insurance (NIHDI). The funding body had a limited role in the study design but no role in data collection, implementation, analysis and decision to publish the results.

Conflict of interest

The authors disclose no financial and personal relationships with other people or organizations that could inappropriately influence their work.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 43 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fournier, A., Anrys, P., Beuscart, JB. et al. Use and Deprescribing of Potentially Inappropriate Medications in Frail Nursing Home Residents. Drugs Aging 37, 917–924 (2020). https://doi.org/10.1007/s40266-020-00805-7

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40266-020-00805-7

Search

Navigation