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Drug Use in a Geriatric Long-Term Care Setting

Comparison between Newly Admitted and Institutionalised Patients

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Abstract

Background and objective

Advanced age, co-morbid diseases, functional dependence and frailty are associated with polypharmacy and overall high health expenditures. Polypharmacy is commonly defined as the concomitant ingestion of four or more medications, particularly in community-dwelling patients, but the number of drugs being taken by institutionalised and hospitalised patients may be as high as ten. The aim of this study was to compare drug use in newly admitted patients (AP) to a geriatric medical centre for long-term care (LTC) with that of institutionalised patients (IP) at the centre.

Methods

A cross-sectional study was conducted, between January 2001 and December 2002, in 324 functionally dependent and cognitively impaired elderly patients (≥65 years of age), consisting of 167 IP (127 females, 40 males) staying at the centre for ≥3 months and 157 (117 females, 40 males) consecutive new admissions for LTC. All patients underwent a comprehensive geriatric assessment, which included a structured medical history, history of drug use, physical examination and functional and cognitive examinations. Overall drug use, drug categories and the basis of use (regular and/or as needed) were compared between the two groups of patients. The pattern of drug use was defined as use of drugs either on a ‘regular’ basis or on an ‘as needed’ basis at any time during the 3 weeks preceding the comprehensive geriatric assessment.

Results

IPs were younger, more dependent, more cognitively impaired, had more co-morbidity and had nonsignificantly higher overall drug use than APs. APs used drugs mainly on a ‘regular’ basis. All of the IPs and most (97%) of the APs were taking drugs according to regular regimens. However, advanced age in IPs was associated with lower overall drug use, predominantly of medications taken on a ‘regular’ basis, and higher use of drugs taken on an ‘as needed’ basis, whereas in APs, advanced age was associated with higher use of both types of medications.

Conclusion

IPs used more drugs on an ‘as needed’ basis, probably because of closer medical supervision of these patients than those in the community. Better knowledge of the patient’s medical condition and treatment, together with better monitoring in the community through patient caregiver instruction, on the one hand, and computerisation of medical data accessible to all healthcare providers, on the other hand, might reduce drug use on a regular basis and, consequently, the costly and adverse effects of polypharmacy.

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Notes

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References

  1. Fuchs Z, Novikov I, Blumstein T, et al. Patterns of drug use among the community-dwelling old-old population in Israel. Isr Med Assoc J 2003; 5: 346–51

    PubMed  Google Scholar 

  2. United Nations. World population prospects: the 2000 revision and world urbanization prospects. New York: Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat, 2002

    Google Scholar 

  3. Federal Interagency Forum on Aging-Related Statistics. Older Americans 2000: key indicators of well-being, population [online]. Available from URL: http://www.agingstats.gov/chartbook2000/default.htm [Accessed 2006 Jan 10]

  4. The population in Israel, by religion, sex, age: end of year 2004 [online]. Available from URL: http://wwwl.cbs.gov.il/Society&Population/Population&Demography/popisrTable3PDF [Accessed 2006 Jan 10]

  5. Central Bureau of Census. Projections of population in Israel for 2010–2025, by sex age and population group [online]. Available from URL: http://wwwl.cbs.gov.il/Society&Population/Population&Demography/popisr/Table5PDF [Accessed 2006 Jan 10]

  6. Shmueli A. Levy Y. Utilization of health care services in Israel by age [in Hebrew]. Bitachon Sociali 1996; 49: 146–53

    Google Scholar 

  7. The 65+, numbers and facts [in Hebrew]. Jerusalem: Mashav, Eshel, Joint-Brookdale Institute for Gerontology and Development of Man and Society, 2002

  8. Habot B, Tsin S. Geriatrics in the new millennium, Israel. Isr Med Assoc J 2003; 5: 319–21

    PubMed  Google Scholar 

  9. Chrischilles EA, Foley DJ, Wallace RB, et al. Use of medications by persons 65 and over: data from the established populations for epidemiologic studies of the elderly. J Gerontol 1992; 42: M137–44

    Article  Google Scholar 

  10. Rollason V, Vogt N. Reduction of polypharmacy in the elderly: a systematic review of the role of the pharmacist. Drugs Aging 2003; 20: 817–32

    Article  PubMed  Google Scholar 

  11. Chutka DS, Takahashi PY, Hoel RW. Inappropriate medications for elderly patients. Mayo Clin Proc 2004; 79: 122–39

    Article  PubMed  CAS  Google Scholar 

  12. AARP administration on aging: a profile of older Americans, 1999. Washington, DC: AARP (American Association of Retired Persons), 1999

  13. Kagansky N, Berner Y, Koren-Morag N, et al. Poor nutritional habits are predictors of poor outcome in very old hospitalized patients. Am J Clin Nutr 2005; 82: 784–91

    PubMed  CAS  Google Scholar 

  14. Klang S. Drug prescription in Clalit Health Services: an unpublished presentation by the Head of Clinical Pharmacology Clalit Health Services in an internal conference of General and Geriatric Medicine at Meir Medical Center. Kfar Saba, Israel: Meir Medical Center, 2004 Nov 26 (Data on file)

    Google Scholar 

  15. Feldman J, Peleg L, Yaretzky A. Comprehensive geriatric assessment: its clinical, social and economic importance and prospects. Harefuah 1999; 136: 933–5

    PubMed  CAS  Google Scholar 

  16. Ellis G, Langhorne P. Comprehensive geriatric assessment for older hospital patients. Brit Med Bull 2005; 71: 45–59

    Article  PubMed  Google Scholar 

  17. Folstein MF, Folstein SE, McHugh PR. Mini-mental state: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12: 189–98

    Article  PubMed  CAS  Google Scholar 

  18. Katz S, Ford AB, Moskowitz RW. The index of ADL, a standardized measure of biological and psychological function. JAMA 1963; 185: 914–9

    Article  PubMed  CAS  Google Scholar 

  19. Bjerrum L, Søgaard J, Hallas J, et al. Polypharmacy: correlations with sex, age and drug regimen: a prescription database study. Eur J Clin Pharmacol 1998; 54: 197–202

    Article  PubMed  CAS  Google Scholar 

  20. Kroenke K. Polypharmacy: causes, consequences, and cure. Am J Med 1985; 79: 149–52

    Article  PubMed  CAS  Google Scholar 

  21. Giron MST, Wang H-X, Bernstein C, et al. The appropriateness of drug use in an older nondemented and demented population. J Am Geriatr Soc 2001; 49: 277–83

    Article  PubMed  CAS  Google Scholar 

  22. Giron MST, Claesson C, Thorslund M. Drug use patterns in a very elderly population: a seven-year review. Clin Drug Invest 1999; 17: 389–98

    Article  Google Scholar 

  23. Linjakumpu T, Hartikainen S, Klaukka T, et al. Use of medications and polypharmacy are increasing among the elderly. J Clin Epidemiol 2002; 55: 809–17

    Article  PubMed  Google Scholar 

  24. Avorn J, Gurwitz JH. Drug use in the nursing home. Ann Int Med 1995; 123: 195–204

    PubMed  CAS  Google Scholar 

  25. Fuchs Z, Blumstein T, Novikov I, et al. Morbidity, comorbidity and their association with disability among community dwelling oldest-old in Israel. J Gerontol Med Sci 1998; 53A: M447–55

    Article  Google Scholar 

  26. Lassila HC, Stoehr GP, Ganguli M, et al. Use of prescription medications in an elderly rural population: the MoVIES Project. Ann Pharmacother 1996; 30: 589–95

    PubMed  CAS  Google Scholar 

  27. Jylhä M. Ten-year change in the use of medical drugs among the elderly: a longitudinal study and cohort comparison. J Clin Epidemiol 1994; 47: 69–79

    Article  PubMed  Google Scholar 

  28. Helling DK, Lemke JH, Semla TP, et al. Medication use characteristics in the elderly: the Iowa 65+ Rural Health Study. J Am Geriatr Soc 1987; 35: 4–12

    PubMed  CAS  Google Scholar 

  29. Barat I, Andreasen F, Damsgaard EMS. The consumption of drugs by 75-year-old individuals living in their own homes. Eur J Clin Pharmacol 2000; 56: 501–9

    Article  PubMed  CAS  Google Scholar 

  30. Jorgensen T, Johansson S, Kennerfalk A, et al. Prescribing drug use, diagnoses, and healthcare utilization among the elderly. Ann Pharmacother 2001; 35: 1004–9

    Article  PubMed  CAS  Google Scholar 

  31. Thomas HF, Sweetnam PM, Janchawee B, et al. Polypharmacy among older men in South Wales. Eur J Clin Pharmacol 1999; 55: 411–5

    Article  PubMed  CAS  Google Scholar 

  32. Rumble RH, Morgan K. Longitudinal trends in prescribing for elderly patients: two surveys four years apart. Br J Gen Pract 1994; 44: 571–5

    PubMed  CAS  Google Scholar 

  33. Rovner BW, German PS, Broadhead J, et al. The prevalence and management of dementia and other psychiatric disorders in nursing homes. Int Psychogeriatr 1990; 2: 13–24

    Article  PubMed  CAS  Google Scholar 

  34. Beardsley RS, Larson DB, Burns BJ, et al. Prescribing of psychotropics in elderly nursing home patients. J Am Geriatr Soc 1989; 37: 327–30

    PubMed  CAS  Google Scholar 

  35. Avorn J, Dreyer P, Connelly K, et al. Use of psychoactive medication and the quality of care in rest homes: findings and policy implications of statewide study. N Engl J Med 1989; 320: 227–32

    Article  PubMed  CAS  Google Scholar 

  36. Everitt DE, Fields DR, Soumerai SS, et al. Resident behavioral and staff distress in the nursing home. J Am Geriatr Soc 1991; 39: 792–8

    PubMed  CAS  Google Scholar 

  37. Beers M, Avorn J, Soumerai SB, et al. Psychoactive medication use in intermediate-care facility residents. JAMA 1988; 260: 3016–20

    Article  PubMed  CAS  Google Scholar 

  38. van Dijk KH, de Vries CS, van den Berg PB, et al. Drug utilization in Dutch nursing homes. Eur J Clin Pharmacol 2000; 55: 765–71

    Article  PubMed  Google Scholar 

  39. Claesson CB. Drug use in Swedish nursing home. Clin Drug Invest 1998; 16: 441–52

    Article  CAS  Google Scholar 

  40. Snowdon J, Vaughan R, Miller R, et al. Psychotropic drug use in Sydney nursing homes. Med J Aust 1995; 163: 70–2

    PubMed  CAS  Google Scholar 

  41. Fahey T, Montgomery AA, Barnes J, et al. Quality of care for elderly residents in nursing homes and elderly people living at home: controlled observational study. BMJ 2003; 326: 580–5

    Article  PubMed  Google Scholar 

  42. Stoehr GP, Ganguli M, Seaberg EC, et al. Over-the-counter medication use in an older rural community: the MoVIES project. J Am Geriatr Soc 1997; 45: 158–65

    PubMed  CAS  Google Scholar 

  43. Wasserfallen JB, Bourgeois R, Büla C, et al. Composition and cost of drugs stored at home by elderly patients. Ann Pharmacother 2003; 37: 731–7

    Article  PubMed  Google Scholar 

  44. Doshi JA, Shaffer T, Briesacher BA. National estimates of medication use in nursing homes: findings from the 1997 medicare current beneficiary survey and the 1996 medical expenditure survey. J Am Geriatr Soc 2005; 53: 438–43

    Article  PubMed  Google Scholar 

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Acknowledgements

No sources of funding were used to assist in the preparation of this study. The authors have no conflicts of interest that are directly relevant to the content of this study.

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Authors and Affiliations

  1. Department of Geriatric Medicine, Meir Hospital, 57 Tchernichovski St, Kfar Saba, 44281, Israel

    Zeev Arinzon & Yitshal N. Berner

  2. Meuhedet Health Care System, Shomron, Netanya, Israel

    Alexander Peisakh & Aneta Zuta

  3. Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel

    Yitshal N. Berner

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  1. Zeev Arinzon
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  2. Alexander Peisakh
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  3. Aneta Zuta
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  4. Yitshal N. Berner
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Correspondence to Zeev Arinzon.

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Arinzon, Z., Peisakh, A., Zuta, A. et al. Drug Use in a Geriatric Long-Term Care Setting. Drugs Aging 23, 157–165 (2006). https://doi.org/10.2165/00002512-200623020-00005

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