Are Older Adults Inappropriately Prescribed Medications in Residential Care? – Medical News Bulletin

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Potentially inappropriate medications (PIMs) usage is associated with adverse complications in the older adult population. In a recent study, researchers determine the costs associated with PIMs and the difference between cases in residential care and traditional aged facilities.

 

Polypharmacy is the concurrent use of numerous drugs to treat a single condition. Individuals prescribed more than five pharmaceuticals is a growing trend observed in residential care facilities. Studies indicate that approximately 50% of residents were exposed to potentially inappropriate medication (PIM) use in 2015 leading to complications including an increased risk of disability, hospitality, and mortality. This trend is concerning as older adults become reliant on medications due to the multi-morbidities associated with aging.

Previous research has observed a high prevalence of PIMs in care homes but has not determined whether different models of residential care show the same incidence of PIMs. An Australian study in BMC Geriatrics determined the costs associated with PIMs and whether there was a difference between the incidences of PIMs in home-like residential care models when compared to traditional aged facilities.

In their cross-sectional, observational study, researchers recruited their participants from aged care facilities around Australia. Participants were eligible for the study if they fulfilled the following criteria:

  • They were a permanent resident of the home
  • They were not in palliative care
  • They had limited family issues that would limit participation
  • They had a family member willing to be a proxy if needed

Researchers invited 901 older adults to participate. The researchers retrieved dispensing records from the participant’s pharmacy to observe their medication history from the year before. The Beers Criteria 2015 and certified pharmacists involved in the study determined whether a pharmaceutical was classified as PIMs.

To determine costs associated with PIMs, researchers used the Dispensed Price for Maximum Quantity (DPMQ). A 12-month cost of each participant’s PIMs was calculated and reported as AUD dollars. The home-like residential care models used in the study were homes designed to make the environment feel more like a domestic home. Results show the mean number of medications participants were exposed to over 12 months was 14.5, costing an average of AUD$1991.86. When comparing residential care homes to the home-like residential care model, results show the likelihood of PIMs was 52% lower for those living in the home-like model of residential care.

The results showcase how older adults are often highly exposed to PIMs. However, living in a home-like model of care demonstrates a significant reduction in PIMs usage, although the reasons for this remain unclear. Around AUD$9 billion is annually spent on aged care services and reducing PIMs could save around AUD$38 million in Australia alone. Future studies encourage physicians to de-prescribe prescription drugs to reduce their indirect and direct costs. Researchers also encourage physicians to come up with non-pharmacological alternatives but still keeping in mind these alternatives pose their own risk factors.

Written by Jennifer Kaitlyn Chiu, BA (Hons)

Reference: Harrison, S. L., O’Donnell, L. K., Milte, R., Dyer, S. M., Gnanamanickam, E. S., Bradley, E. L., Hilmer, S. N., & Crotty, M. (2018). Costs of potentially inappropriate medication use in residential aged care facilities. BMC Geriatrics, 18(9), 1-10. https://dx.doi.org/10.1186/s12877-0.18-0704-8.



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