Summary
The study of prescribing for the elderly in the US is in its infancy. Nursing home studies provide some of the most reliable data. In US nursing homes, each resident is prescribed an average of between 7.2 and 8.1 medications, with gastrointestinal agents being the most frequent. The vision for prescribing in the US involves avoidance of polypharmacy and specific groups of medications. Approaches to treatment in the US for certain conditions that can be prevented are addressed, specifically pain control, osteoporosis, stroke, cardiovascular disease, cognitive impairment and infection.
Similar content being viewed by others
References
Meier DE. Voiceless and vulnerable: dementia patients without surrogates in an era of capitation. J Am Geriatr Soc 1997 Mar; 45(3): 375–7
Hamel M, Phillips R, Teno J. et al. Seriously ill hospitalized adults: do we spend less on older patients?. J Am Geriatr Soc 1996 Sep; 44(9): 1043–8
Perls T, Wood E. Acute care costs of the oldest old: they cost less, their care intensity is less, and they go to nonteaching hospitals. Arch Intern Med 1996 Apr 8; 156: 754–61
Delafuente JC, Meuleman JR, Conlin M, et al. Drug use among functionally active, aged, ambulatory people. Ann Phar-macother 1992 Feb 2; 26: 179–83
Stover K. GAO reports. Pharmacy Today 1995; 1 (14): 8
Steiner JF. Pharmacotherapy problems in the elderly. J Am Pharm Assoc 1996 Jul; NS36(7): 431–7, 467
Avorn J, Gurwitz JH. Drug use in the nursing home. Ann Intern Med 1995 Aug 1; 123(3): 195–204
Beers MH, Ouslander JG, Fingold SF, et al. Inappropriate medication prescribing in skilled-nursing facilities. Ann Intern Med 1992 Oct 15; 117(8): 684–9
Office of Research and Demonstrations. Health care financing, program statistics, Medicare and Medicaid data book, 1990 (HCFA pub. no. 03314). Baltimore (MD): US Department of Health and Human Services, Health Care Financing Administration, 1991 Mar
Gurwitz JH, Soumerai SB, Avorn J. Improving medication prescribing and utilization in the nursing home. J Am Geriatr Soc 1990 May; 38(5): 542–52
Shorr RI, Fought RL, Ray WA. Changes in antipsychotic drug use in nursing homes during implementation of OBRA-87 regulations. JAMA 1994 Feb 2; 271(5): 358–62
Beers MH, Fingold SF, Ouslander JG, et al. Characteristics and quality of prescribing by doctors practising in nursing homes. J Am Geriatr Soc 1993; 41(8): 802–7
Beers MH, Avorn J, Soumerai SB, et al. Psychoactive medication use in intermediate-care facility residents. JAMA 1988 Nov 25; 260(20): 3016–20
Lynn J, Teno JM, Phillips RS. Perceptions by family members of the dying experience of older and seriously ill patients. Ann Intern Med 1997 Jan 15; 126(2): 97–106
Tolle SW, Bascom P. Drug use in the nursing home [letter]. Ann Intern Med 1996 Mar 15; 124(6): 616
Stein WM, Ferrell BA. Pain in the nursing home. Clin Geriatr Med 1996 Aug; 12(3): 601–13
Kaufman DW, Kelly JP, Sheehan JE, et al. Nonsteroidal anti-inflammatory drug use in relation to major upper gastrointestinal bleeding. Clin Pharm Ther 1993 Apr; 53(4): 485–94
Hochain P, Berkelmans I, Czernichow P, et al. Which patients taking non-aspirin non-steroidal anti-inflammatory drugs bleed? A case-control study. Eur J Gastroenterol Hepatol 1995 May; 7(5): 419–26
Enck RE. Management of terminally ill nursing home residents. Nurs Home Med 1996 Nov; 4(11): 348–53
Hurley AC, Volicer BJ, Hanrahan PA, et al. Assessment of discomfort in advanced Alzheimer patients. Res Nurs Health 1992; 15: 369–77
Handa VL, Landerman R, Hanlon JT, et al. Do older women use estrogen replacement? Data from the Duke Established Populations for Epidemiologic Studies of the Elderly (EP-ESE). J Am Geriatr Soc 1996 Jan; 44(1): 1–6
Cauley JA, Cummings SR, Black DM, et al. Prevalence and determinants of estrogen replacement therapy in elderly women. Am J Obstet Gynecol 1990 Nov; 163(5): 1438–44
Chapuy MC, Arlot ME, Duboeuf F, et al. Vitamin D3 and calcium to prevent hip fractures in elderly women. N Engl J Med 1992 Dec 3; 327(23): 1637–42
Pak CY, Sakhaee K, Adams-Huet B, et al. Treatment of postmenopausal osteoporosis with slow-release sodium fluoride: final report of a randomized controlled trial. Ann Intern Med 1995 Sep 15; 123(6): 401–8
Grady D, Rubin SM, Petitti D, et al. Hormone therapy to prevent disease and prolong life in postmenopausal women. Ann Intern Med 1992 Dec 15; 117(12): 1016–37
Kiel DP, Felson DT, Anderson JJ, et al. Hip fracture and the use of estrogens in postmenopausal women: the Framingham study. N Engl J Med 1987 Nov 5; 317(19): 1169–74
Jacobs HS, Loeffler FE. Postmenopausal hormone replacement therapy. BMJ 1992; 305: 1403–8
Goldman L, Tosteson ANA. Uncertainty about postmenopausal estrogen: time for action, not debate. N Engl J Med 1991; 325: 800–2
Karpf DB, Shapiro DR, Sieman E, et al. Prevention of non-vertebral fractures by alendronate: a meta-analysis. JAMA 1997 Apr 9; 277(14): 1159–64
Chesnut CH, McClung MR, Ensrud KE, et al. Alendronate treatment of the postmenopausal osteoporotic woman: effect of multiple dosages on bone mass and bone remodeling. Am J Med 1995 Aug; 99: 144–52
Black DM, Cummings SR, Karpf DB, Fracture Intervention Trial Research Group, et al. Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Lancet 1996 Dec 7; 348: 1535–41
Liberman UA, Weiss SR, Broil J, et al. Effect of oral alendronate on bone mineral density and the incidence of fractures in postmenopausal osteoporosis. N Engl J Med 1995 Nov 30; 333(22): 1437–43
Overgaard K, Hansen MA, Jensen SB, et al. Effect of salcatonin given intranasally on bone mass and fracture rates in established osteoporosis: a dose-response study. BMJ 1992 Sep 5; 305: 556–61
Gurwitz JH, Monette J, Rochon PA, et al. Atrial fibrillation and stroke prevention with warfarin in the long-term care setting. Arch Intern Med 1997 May 12; 157: 978–84
Schlicht JR, Davis RC, Naqi K, et al. Physician practices regarding anticoagulation and cardioversion of atrial fibrillation. Arch Intern Med 1996 Feb; 156(3): 290–4
Ezekowitz MD, Bridgers SL, James KE, et al, For the Veterans Affairs Stroke Prevention in Nonrheumatic Atrial Fibrillation Investigators. Warfarin in the prevention of stroke associated with nonrheumatic atrial fibrillation. N Engl J Med 1992 Nov 12; 327(20): 1406–12
Stroke Prevention in the Atrial Fibrillation Investigators. Stroke prevention in atrial fibrillation study: final results. Circulation 1991 Aug; 84(2): 527–39
Petersen P, Boysen G, Godtfredsen J, et al. Placebo-controlled, randomized trial of warfarin and aspirin for prevention of throm-boembolic complications in chronic atrial fibrillation: the Copenhagen AFASAK Study. Lancet 1989 Jan 28; I: 175–9
The Boston Area Anticoagulation Trial for Atrial Fibrillation Investigators. The effect of low-dose warfarin on the risk of stroke in patients with nonrheumatic atrial fibrillation. N Engl J Med 1990 Nov 29; 323(22): 1505–11
Connolly SJ, Laupacis A, Gent M, et al. Canadian Atrial Fibrillation Anticoagulation (CAFA) study. J Am Coll Cardiol 1991 Aug; 18(2): 349–55
Hylek EM, Singer DE. Risk factors for intracranial hemorrhage in outpatients taking warfarin. Ann Intern Med 1994 Jun 1; 120(11): 897–902
ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. Lancet 1988 Aug; II: 349–60
Gruppo Italiano per lo Studio della Streptochinasi nell’ Infarto Miocardico (GISSI). Long-term effects for intravenous thrombolysis in acute myocardial infarction: final report of the GISSI study. Lancet 1987 Oct; II: 871–4
Forman R, Aronow WS. Management of postmyocardial infarction in the elderly patient. Clin Geriatr Med 1996 Feb; 12(1): 169–80
Rovner BW, German PS, Brant LJ, et al. Depression and mortality in nursing homes. JAMA 1991; 265: 993–6
Masand PS. Depression in long-term care facilities. Geriatrics 1995 Oct; 50(S1): S16–24
Preskorn SH. Comparison of the tolerability of bupropion, fluoxetine, imipramine, nefazodone, paroxetine, sertraline, and venlafaxine. J Clin Psychiatry 1995; 56 Suppl. 6: 12–21
Knapp MJ, Knopman DS, Solomon PR, et al. A 30-week randomized controlled trial of high-dose tacrine in patients with Alzheimer’s disease. JAMA 1994 Apr 6; 271(13): 985–91
Wickelgren I. Estrogen stakes claim to cognition. Science 1997 May 2; 276: 675–8
Rich JB, Rasmusson DX, Folstein MF, et al. Nonsteroidal anti-inflammatory drugs in Alzheimer’s disease. Neurology 1995 Jan; 45(1): 51–5
Sano M, Ernesto C, Thomas RG, et al. A controlled trial of selegiline, alpha-tocopherol, or both as treatment for Alzheimer’s disease: the Alzheimer’s Disease Cooperative Study. N Engl J Med 1997 Apr 24; 336(17): 1216–22
Aisen PS, Marin D, Altstiel L, et al. A pilot study of prednisone in Alzheimer’s disease. Dementia 1996 Jul/Aug; 7(4): 201–6
Marx J. Searching for drugs that combat Alzheimer’s. Science 1996 Jul 5; 273: 50–3
Williams WW, Kickson MA, Kane MA, et al. Immunization policies and vaccine coverage among adults: the risk of missed opportunities. Ann Intern Med 1988 Apr; 108(4): 616–25
Govaert TM, Thijs CT, Masurel N, et al. The efficacy of influenza vaccination in elderly individuals. JAMA 1994 Dec 7; 272(21): 1661–5
Shapiro ED, Berg AT, Austrian R, et al. The protective efficacy of polyvalent pneumococcal polysaccharide vaccine. N Engl J Med1991 Nov 21; 325(21): 1453–60
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Broderick, E. Prescribing Patterns for Nursing Home Residents in the US. Drugs & Aging 11, 255–260 (1997). https://doi.org/10.2165/00002512-199711040-00001
Published:
Issue Date:
DOI: https://doi.org/10.2165/00002512-199711040-00001