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Pharmacy World and Science

, Volume 25, Issue 1, pp 30–34 | Cite as

Increase in Drug Use After Admission to Dutch Nursing Homes

  • R.T.C.M. Koopmans
  • J.P. van der Borgh
  • J.H.J. Bor
  • Y.A. Hekster
Article

Abstract

Objective: To study changes in drug use after admission to Dutch nursing homes.Setting. Six nursing homes near the city of Nijmegen, The Netherlands.Design. Prospective longitudinal study.Methods. All patients who had been newly admitted to the nursing home were included in the study. Age, gender, residence of the patients before admission, and indication were registered. All prescriptions were registered with start‐date and end‐date. The nomenclature and subcategory definitions used were those of the World Health Organisation Nordic Anatomical Therapeutic Chemical classification index (ATC) codes. Patients had a follow‐up of six weeks. Results. There was a minor, but statistically significant, increase in the mean number of drugs from 5.6 on admission to 5.8 six weeks later. Patients referred from a hospital and patients with a somatic indication were prescribed the highest number of drugs. On admission 5.5% of the patients were not on medication at all, 48%were using 1‐2 drugs, and 46% had been prescribed 6 or more drugs. Six weeks after admission, a significant increase in drug use was found in drugs for the nervous system, and drugs for the sensory organs. Conclusion. Increase in drug use does not necessarily have to reflect bad prescribing practices. However, in this frail population, continuous drug review is needed to guarantee quality of prescribing and reduce unnecessary polypharmacy.

Drug use Longitudinal study Nursing home patients Polypharmacy Prescribing 

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References

  1. 1.
    Koopmans RTCM, de Vaan HHC, van den Hoogen HJM Gribnau FWJ, Hekster YA, van Weel C. Reduction of drug intake after admission to a psychogeriatric nursing home: discontinuation is possible. Ned Tijdschr Geneeskd 1993; 1049–54 [in Dutch].Google Scholar
  2. 2.
    van Zuylen C, Oostendorp FMGM, van Beusekom BR, Cools HJM, Bolk JH Ligthart GJ. Increasing use of medication in nursing homes. Ned Tijdschr Geneeskd 1988; 132: 1692–5 [in Dutch].Google Scholar
  3. 3.
    Merkus JWFM. Drug-use in three nursing homes. Tijdschr Gerontol Geriatr 1985; 16: 1122–6 [in Dutch].Google Scholar
  4. 4.
    van Dijk KN, de Vries CS, van den Berg PB, Brouwers JRBJ, de Jong-van den Berg LTW. Drug utilisation in Dutch nursing homes. Eur J. Clin Pharmacol 2000; 55: 765–71.Google Scholar
  5. 5.
    van Dijk KN, de Vries CS, van den Berg PB, Brouwers JRBJ, de Jong-van den Berg LTW. Occurrence of potential drug-drug interactions in nursing home residents. Int J Pharm Pract 2001; 9: 45–52.Google Scholar
  6. 6.
    van Dijk KN, de Vries CS, van den Berg PB, Dijkema AM, Brouwers JRBJ, de Jong-van den Berg LTW. Constipation as an adverse effect of drug use in nursing home patients: an overestimated risk. Br J Clin Pharmacol 1998; 46: 255–61.Google Scholar
  7. 7.
    O'Grady M, Weedle P. A descriptive study of drug therapy and cost for elderly residents in a nursing home. I Med J1998; 5: 172–4.Google Scholar
  8. 8.
    Roberts MS, King M, Stokes JA, Lynne TA, Bonnner CJ, McCarthy S et al. Medication prescribing and administration in nursing homes. Age Ageing 1998; 27: 385–92.Google Scholar
  9. 9.
    Gambassi G, Landi F, Lapane KL, Sgadari A, Mor V, Bernabei R. Is drug use by the elderly with cognitive impairment influenced by type of dementia? Pharmacotherapy 1999; 19(4): 430–6.Google Scholar
  10. 10.
    Gambassi G, Landi F, Pend L, Brostrup-Jensen C, Calore K, Hiris J et al. Validity of diagnostic and drug data in standardized nursing home resident assessments. Med Care 1998; 36(2): 167–79.Google Scholar
  11. 11.
    VanderStichele RH, Mestdagh J, Van Haecht CH, De Potter B, Bogaert MG. Medication utilization and patient information in homes for the aged. Eur J Clin Pharmacol 1992; 43: 319–21.Google Scholar
  12. 12.
    Wayne SJ, Rhyne RL, Stratton M. Longitudinal prescribing patterns in a nursing home population. J Am Geriatr Soc 1992; 40: 53–6.Google Scholar
  13. 13.
    Avorn J, Gurwitz JH. Drug use in the nursing home. Ann Intern Med 1995; 123: 195–204.Google Scholar
  14. 14.
    Beers MH, Ouslander JG, Fingold SF, et al. Inappropriate medication prescribing in skilled-nursing facilities. Ann Intern Med 1992; 17: 684–9.Google Scholar
  15. 15.
    Claesson CB, Schmidt IK. Drug Use in Swedish nursing homes. Clin Drug Invest 1998;16(6): 441–52.Google Scholar
  16. 16.
    Koopmans RTCM, de Vaan HHC, van den Hoogen HJM, Gribnau FWJ, Hekster YA, van Weel C. Changes in drug use during the stay in a psychogeriatric nursing home. Ned Tijdschr Geneeskd 1994; 138: 1122–6 [in Dutch].Google Scholar
  17. 17.
    Hoek JF, Pennix BWJH, Ligthart GJ, Ribbe MW. Health care for older persons, a country profile: The Netherlands. J Am Geriatr Soc 2000; 48: 214–7.Google Scholar
  18. 18.
    Anatomic Therapeutic Chemical Classification Index, January 1996. Oslo, Norway: WHO Collaborating Centre for Drug Statistics Methodology.Google Scholar
  19. 19.
    Roberts MS, Stokes JA, King MA et al. Outcomes of a randomized controlled trial of a clinical pharmacy intervention in 52 nursing homes. Br J Clin Pharmacol 2001; 51: 257–65.Google Scholar
  20. 20.
    Khunti K, Kinsella B. Effect of systematic review of medication by general practitioners on drug consumption among nursing-home residents. Age Ageing 2000; 29: 451–5.Google Scholar
  21. 21.
    Schmidt IK, Claesson CB, Westerholm B, Nilsson LG. Physician and staff assessments of drug interventions and outcomes in Swedish nursing homes. Ann Pharmacother 1998; 32: 27–32.Google Scholar
  22. 22.
    Beers MH, Ouslander JG, Fingold SF et al. Inappropriate prescribing in skilled-nursing facilities. Ann Intern Med 1992; 117: 684–9.Google Scholar
  23. 23.
    Williams B, Betley C. Inappropriate use of nonpsychotropic medications in nursing homes. J Am Geriatr Soc 1995; 151: 513–9.Google Scholar
  24. 24.
    Piecoro LT, Browning SR, Prince TS, Ranz TT, Douglas-Scutchfield FD. A database of potentially inappropriate drug use in elderly Medicaid population. Pharmacotherapy 2000; 20: 221–8.Google Scholar
  25. 25.
    Gupta S, Rappaport HM, Bennet LT. Inappropriate prescribing and related outcomes for elderly Medicaid beneficiaries residing in nursing homes. Clin Ther 1996; 18: 183–96.Google Scholar
  26. 26.
    Cohen-Mansfield JC, Lipson S, Werner P, Billig N, Taylor L, Woosley R. Withdrawal of haloperidol, thioridazine, and lorazepam in the nursing home. A controlled, double blind study. Arch Intern Med 1999; 159: 1733–40.Google Scholar
  27. 27.
    Stein CM, Griffin MR, Taylor JA, Pichert JW, Brandt KD, Ray WA. Educational program for nursing home physicians and staff to reduce use of non-steroidal anti-inflammatory drugs among nursing home residents. A randomized controlled trial. Med Care 2001; 39: 436–45.Google Scholar
  28. 28.
    Kraaij van DJW, Jansen RWMM, Gribnau FWJ, Hoefnagels WHL. Use of diuretics and opportunities for withdrawal in a Dutch nursing home population. Neth J Med 1998; 53: 20–6.Google Scholar
  29. 29.
    Froom J, Trilling J. Reducing antihypertensive medication use in nursing home patients. Arc Fam Med 2000; 9: 378–83.Google Scholar
  30. 30.
    Aronow WS. Prevalence of appropriate and inappropriate indications for use of digoxin in older patients at the time of admission to a nursing home. J Am Geriatr Soc 1996; 44: 588–90.Google Scholar

Copyright information

© Kluwer Academic Publishers 2003

Authors and Affiliations

  • R.T.C.M. Koopmans
    • 1
  • J.P. van der Borgh
    • 2
  • J.H.J. Bor
    • 3
  • Y.A. Hekster
    • 4
  1. 1.Department of Nursing Home MedicineUniversity Medical CentreNijmegenThe Netherlands e‐mail
  2. 2.'Joachim en Anna' nursing homeNijmegenThe Netherlands
  3. 3.Department of General PracticeUniversity Medical CentreNijmegenThe Netherlands
  4. 4.Department of Clinical PharmacyUniversity Medical CentreNijmegenThe Netherlands

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