Prescribing potentially inappropria...

Prescribing potentially inappropriate medications befalls in various health care settings, and older patients are especially at risk of adverse imports from polypharmacy. Studies have base a link between inappropriate medication prescriptions and after major health events including falls, hospitalizations, and death. A contemplation found that 50 percent of nursing family circle residents received an inappropriate medication prescription during united year; of those, one in three received it for in the greatest degree of their nursing home stay. Inappropriate remedy choice was the most universal error, but other errors included excessive medication dosage and drug-disease interactions. Lau and colleagues evaluated the relationship between potentially inappropriate medication prescriptions and after adverse events (i.e., hospitalization and death) in older longterm nursing residence residents.

The authors studied data from the 1996 Medical Expenditure Panel inspect Nursing Home Component, a national measure and estimate of nursing home staff and residents. The contemplate assessed nursing home use and expenditures for nursing abiding-place patients admitted during 1996. Prescribing data were obtained from administration records and medical charts. The meditation included nursing home residents 65 years and older whose stays lasted at least three consecutive month The criteria for potentially inappropriate medication prescribing included inappropriate unsalable article choice, excessive dosage, and drug-disease interaction. Resident, facility characteristics, hospitalization, and death data were obtained from nursing household records.

Final analysis included 3372 residents. During the subject of attention year, one half received undivided or more potentially inappropriate medication prescriptions. The mostly common therapeutic classes included narcotics, antihistamines with robust anticholinergic effects, sedatives/ hypnotics, gastrointestinal/antispasmodic agents, antidepressants, platelet inhibitors, and iron postscripts One third of participants were hospitalized at least one time during the year, and nearly united in five died. Residents who received potentially inappropriate medications had a greater risk (odd ratio [OR], 127) of hospitalization in the following month compared with those who did not. Residents who received potentially inappropriate medications for brace consecutive months also had a significantly higher not divisible by 2s ratio (OR, 1.27) compared with those who did not. The risk of death was greater in residents who received potentially inappropriate medications that month (OR, 128) compared with those who did not. Residents who received intermittent exposing to potentially inappropriate medications were also at a greater risk of death (OR, 189)

The authors bring to an end that nursing home residents expos to potentially inappropriate medications are at greater risk for hospitalization and death than those who have no aspect This study provides new evidence supporting the importance of improving prescribing habits and regulation in nursing homes

EDITOR'S NOTE: Inappropriate medication prescribing has been identified as a question at issue for older patients in multiple settings. Another research (1) published recently by Zhan and associates build similar potentially harmful drug-drug and drug-disease interaction in outpatient care of older patients. one as well as the other of these studies point to the importance of understanding that medications can have a significantly negative impact in succession older patients. Both studies state that bodys need to be created to identify potentially inappropriate medications, and physicians ne to evolve a better understanding of this issue when providing care for older patients.--K.E.M.

REFERENCE

(1) Zhan C Correa-de-Araujo R Bierman AS, Sangl J Miller MR Wickizer SW et al. Suboptimal prescribing in somewhat advanced in life outpatients: potentially harmful drug-drug and drug-disease combinations. J Am Geriatr Soc February 2005;53:262-7

KARL E MILLER, MD

Lau DT et al. Hospitalization and death associated with potentially inappropriate medication prescriptions among somewhat old nursing home residents. Arch Intern M January 10 2005;165:68-74

COPYRIGHT 2005 American Academy of Family Physicians

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