Potentially Inappropriate Prescribing in Older People with Dementia in Care Homes
- 393 Downloads
Background: Older people in general and care home residents in particular are at high risk of suboptimal or inappropriate prescribing. To date, research into potentially inappropriate prescribing (PIP) has not focused on care home residents and/or has not utilized the recently developed and validated Screening Tool of Older Persons’ potentially inappropriate Prescriptions (STOPP) criteria.
Objective: The aim of this study was to estimate the prevalence of PIP in older people with dementia living in six residential care homes in England, using the STOPP criteria.
Methods: A retrospective analysis was conducted using medication data collected for older people with dementia in six residential care homes in England who participated in the prospective, longitudinal EVIDEM — End of Life (EoL) study. Of the 133 residents recruited to the study, medication administration records were available for and reviewed at two timepoints (approximately 16 weeks apart) for 119 residents and 110 residents, respectively. The prevalence of PIP at these timepoints was determined using 31 of the 65 STOPP criteria applicable when there is no access to residents’ medical records.
Results: At the first timepoint, 68 potentially inappropriate medications (PIMs) were identified. Fifty-five residents (46.2%) were prescribed one or more PIM(s), eleven (9.2%) were prescribed two or more PIMs and two (1.7%) were prescribed three PIMs. Thirteen of the 31 STOPP criteria utilized in this study (41.9%) were used to identify PIP. Long-term (i.e. >1 month) neuroleptics (antipsychotics) were the most frequently prescribed PIMs (n = 25; 21.0%), followed by non-steroidal anti-inflammatory drugs (NSAIDs) for >3 months, proton pump inhibitors (PPIs) at maximum therapeutic dosage for >8 weeks, tricyclic antidepressants (TCAs) in patients with dementia and long-term (i.e. >1 month), long-acting benzodiazepines.
At the second timepoint, 57 PIMs were identified; 45 residents (40.9%) were prescribed one or more PIM(s) and 10 (9.1%) were prescribed two or more PIMs, but only one resident (0.9%) was prescribed three PIMs. Of the 31 STOPP criteria utilized in this study, ten (32.3%) were used to identify PIP. Long-term (i.e. >1 month) antipsychotics were again the most frequently prescribed PIMs (n = 21; 19.1%), followed by PPIs at maximum therapeutic dosage for >8 weeks, NSAIDS for >3 months and TCAs in patients with dementia.
A significant correlation was found at both timepoints between the number of medicines prescribed and occurrence of PIP.
Conclusions: This study found that over two-fifths of older people with dementia residing in six residential care homes in England were prescribed at least one PIM at each timepoint. Long-term (i.e. >1 month) antipsychotics, NSAID use for >3 months and PPI use at maximum therapeutic dosage for >8 weeks were the most prevalent PIMs. Regular medication review that targets, but is not limited to, these medications is required to reduce PIP in the residential care home setting. The STOPP criteria represent a useful tool to facilitate such review in this patient population.
Funding sources: Carole Parsons and Sarah Johnston had no financial support from any organization for the submitted work. Elspeth Mathie, Natasha Baron, Ina Machen, Sarah Amador and Claire Goodman had financial support from the National Institute for Health Research (NIHR) Programme Grants for Applied Research Funding scheme for the submitted work. The authors’ work was independent of the funders; the NIHR did not contribute to the study design; the collection, analysis or interpretation of data; the writing of the report; or the decision to submit the article for publication
Conflicts of interest: None of the authors have any conflicts of interest that are directly relevant to the content of this article.
Author contributions: Carole Parsons drafted the manuscript and participated in the analysis and interpretation of the data. Sarah Johnston participated in the analysis and interpretation of the data. Natasha Baron, Elspeth Mathie, and Ina Machen supported the data collection and analysis of the findings and commented on drafts of the manuscript. Sarah Amador supported data analysis and final checks on data. Claire Goodman is the lead investigator; she designed the study and contributed sections of the manuscript and commented on all drafts. Carole Parsons and Claire Goodman are guarantors for the study. The paper is an accurate representation of the study results.
Other contributions: Elizabeth Stevenson assisted with the data collection and analysis of the findings. She has received financial support from the NIHR Programme Grants for Applied Research Funding scheme for the submitted work.
The authors wish to thank the participating residents, their relatives and the residential care home staff who enabled this study to be undertaken.
- 1.Office for National Statistics. Statistical Bulletin: Older People’s Day 2011. Newport: Office for National Statistics, 2011 Sep 29Google Scholar
- 25.Ryan C, O’Mahony D, Kennedy J, et al. Appropriate prescribing in the elderly: an investigation of two screening tools, Beers criteria considering diagnosis and independent of diagnosis and improved prescribing in the elderly tool to identify inappropriate use of medicines in the elderly in primary care in Ireland. J Clin Pharm Ther 2009 Aug; 34(4): 369–76PubMedCrossRefGoogle Scholar
- 33.García-Gollarte F, Baleriola-Júlvez J, Ferrero-López I, et al. Inappropriate drug prescription at nursing home admission. J Am Med Dir Assoc. Epub 2011 Mar 31, doi:10.1016/j.jamda.2011.02.009Google Scholar
- 35.Alzheimer’s Society. Dementia UK: a report into the prevalence and cost of dementia prepared by the Personal Social Services Research Unit (PSSRU) at the London School of Economics and the Institute of Psychiatry at King’s College. London: Alzheimer’s Society, 2007Google Scholar
- 37.ATC/DDD index 2011. Oslo: WHO Collaborating Centre for Drug Statistics Methodology, Norwegian Institute of Public Health [online]. Available from URL: http://www.whocc.no/atc_ddd_index/ [Accessed 2011 Jan 24]
- 39.O’Sullivan DP, O’Mahony D, Byrne S. Potentially inappropriate prescribing in Irish nursing home residents [abstract]. Eur Geriatr Med 2010; 1Suppl. 1: S82Google Scholar
- 51.Department of Health. The use of antipsychotic medication for people with dementia: time for action. A report for the Minister of State for Care Services by Professor Sube Banerjee. London: Department of Health, 2009Google Scholar