Michiko Inaba

Outcomes of polypharmacy in nursing home residents.

This article provides a comprehensive review of the outcomes of polypharmacy in nursing homes. Our review had some limitations. First, we only included studies beginning in 1990, and significant earlier studies are not included. Only English language articles were included. We only researched studies from MEDLINE, and may have missed studies based on our search terms and search tools. There are many definitions of polypharmacy in the literature, including number of medications or inappropriate medications. In this review, we defined polypharmacy as a high number of medications, but not inappropriate medications. It was not surprising that polypharmacy was consistently associated with an increased number of potentially inappropriate drugs. The majority of studies were viewed showed that polypharmacy was associated with increased ADEs, increased DDIs, and increased hospitalizations. We were surprised that polypharmacy was not consistently linked with falls, fractures, and mortality. For the mortality studies, it has been postulated that perhaps some patients receiving 10 or more medications may have been moribund or receiving end-of-life or hospice care. It is possible that the number of medications is not as important as the number of potentially in appropriate drugs. There need to be more studies on these outcomes, using different definitions of polypharmacy. Polypharmacy was associated with increased costs. The drug-related morbidity and mortality, including those resulting from inappropriate medications and increased staff time, led to increased costs. Use of consultant pharmacists has been shown to decrease polypharmacy costs.

Reducing Cost by Reducing Polypharmacy: The Polypharmacy Outcomes Project

OBJECTIVE To examine the effect of intervention by geriatric medicine fellows and a geriatrician on medication cost among long term care residents with polypharmacy. DESIGN Interventional study. SETTING A single hospital-affiliated long term care facility. PARTICIPANTS Long term care residents with polypharmacy, defined as being on 9 or more medications. INTERVENTION Medication lists of all nursing home residents were reviewed in October 2007 by geriatric medicine fellows and a faculty geriatrician using the 2003 Beers Criteria and the Epocrates online drug-drug interaction program. Recommendations for each resident were prepared and discussed directly with their primary physicians, who made the final decisions regarding medication discontinuation or taper. MEASUREMENTS Mean monthly costs (derived from current retail prices) for overall as well as scheduled and pro re nata (PRN) medications were compared before and after the intervention. Estimated reduction in nursing administration time and cost were calculated based on published literature on medication administration time and nursing labor costs. RESULTS Seventy-four (46.3%) of 160 residents were on 9 or more medications. Four residents died or were discharged before the intervention, leaving a final sample of 70 residents for the intervention. After the intervention, mean monthly medication costs per resident significantly decreased; overall medications, from

White Matter Lesions on Brain Magnetic Resonance Imaging Scan and 5-Year Cognitive Decline: The Honolulu-Asia Aging Study

874.27 to

Factors associated with polypharmacy in nursing home residents.

843.56 (P < .0001); scheduled medications, from

Combining Quality Improvement and Geriatrics Training: The Nursing Home Polypharmacy Outcomes Project

814.05 to

PET-positive extralimbic presentation of anti-glutamic acid decarboxylase antibody-associated encephalitis

801.14 (P= .007); PRN medications, from

Unveiling adrenal insufficiency can make a difference in elderly adults.

60.22 to

White Matter Lesions on Brain Magnetic Resonance Imaging Scan and 5-Year Cognitive Decline: The Honolulu-Asia Aging Study: WHITE MATTER LESIONS AND COGNITIVE DECLINE

42.43 (P < .0001). Gastrointestinal medications demonstrated the highest cost savings of all medication categories (eg, promethazine and proton pump inhibitors), followed by central nervous system-active medications (including benzodiazepines and fluoxetine), then analgesics and diabetes medications. CONCLUSION This polypharmacy reduction intervention by physicians used readily available tools, demonstrated a significant decrease in medication-related costs, and provided training in the core competencies of practice-based learning and improvement and systems-based practice to geriatric medicine fellows in long term care.

White Matter Lesions on Brain MRI Scan and 5-Year Cognitive Decline: The Honolulu-Asia Aging Study

OBJECTIVES: To study white matter lesions (WMLs) and 5‐year cognitive decline in elderly Japanese‐American men.

Creutzfeldt-Jakob Disease: A Case Report and Differential Diagnoses

The prevalence of polypharmacy is very high in the nursing home setting. In this comprehensive review, we describe the many demographic, functional status, chronic disease, and healthcare financing factors associated with polypharmacy in nursing home patients. Recognition of the factors associated with polypharmacy is the first step for practitioners. A quality improvement intervention study previously conducted by the authors of this paper demonstrated that polypharmacy can be reduced in the nursing setting as a result of systematic review of medications by physicians.