Medications in long-term care: When less is more

Clinics in Geriatric Medicine

Volumn 27, Issue 2, 2011, Pages 171-191

  Meeks, Thomas W ^a   Culberson, John W ^b,c   Horton, Monica S ^d,e  

^a UNIVERSITY OF CALIFORNIA   (United States)

^b BAYLOR COLLEGE OF MEDICINE   (United States)

^c MICHAEL E DEBAKEY VETERANS AFFAIRS MEDICAL CENTER   (United States)

^d UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT SAN ANTONIO   (United States)

^e SOUTH TEXAS VETERANS HEALTH CARE SYSTEM   (United States)

Author keywords

Inappropriate prescribing; Long term care; Opiates; Polypharmacy; Psychotropics; Sedatives

Indexed keywords

ANALGESIC AGENT; ANTIDEPRESSANT AGENT; ARIPIPRAZOLE; ATYPICAL ANTIPSYCHOTIC AGENT; BENZODIAZEPINE DERIVATIVE; CLOZAPINE; DESIPRAMINE; DIAZEPAM; GABAPENTIN; HYDROCODONE; HYDROMORPHONE; LORAZEPAM; NARCOTIC ANALGESIC AGENT; NEUROLEPTIC AGENT; NONSTEROID ANTIINFLAMMATORY AGENT; NORTRIPTYLINE; OLANZAPINE; OLEPTRO; OXYCODONE; PARACETAMOL; PLACEBO; PREGABALIN; QUETIAPINE; RAMELTEON; RISPERIDONE; STEROID; TEMAZEPAM; TRAZODONE; TRICYCLIC ANTIDEPRESSANT AGENT; UNCLASSIFIED DRUG; UNINDEXED DRUG; ZIPRASIDONE;

AGGRESSION; ALZHEIMER DISEASE; ANALGESIA; ANXIETY DISORDER; ASPIRATION PNEUMONIA; BEDTIME DOSAGE; CEREBROVASCULAR ACCIDENT; CLINICAL PRACTICE; CONSTIPATION; DATA BASE; DECISION MAKING; DEMENTIA; DEPRESSION; DIFFUSE LEWY BODY DISEASE; DRUG BLOOD LEVEL; DRUG DOSE TITRATION; DRUG EFFICACY; DRUG HALF LIFE; DRUG METABOLISM; DRUG SAFETY; DRUG USE; DRUG WITHDRAWAL; DYSLIPIDEMIA; ELDERLY CARE; FALLING; FRONTOTEMPORAL DEMENTIA; HEART DEATH; HUMAN; HYPERGLYCEMIA; INAPPROPRIATE PRESCRIBING; INSOMNIA; INSULIN RESISTANCE; LONG TERM CARE; MAJOR DEPRESSION; MEDICAL EXPERT; MENTAL DISEASE; METABOLIC DISORDER; MULTIINFARCT DEMENTIA; NEUROPATHIC PAIN; NEUROPSYCHIATRY; OBESITY; OSTEOPOROSIS; PAIN; PARKINSONISM; PATIENT CARE; POLYPHARMACY; PRESCRIPTION; PSYCHOSIS; PSYCHOTHERAPY; QT PROLONGATION; QUALITY OF LIFE; RESTLESS LEGS SYNDROME; REVIEW; RISK ASSESSMENT; SCHIZOPHRENIA; SEDATION; SIDE EFFECT; SLEEP DISORDER; SPINAL CORD DECOMPRESSION; STROKE; TARDIVE DYSKINESIA; TRANSCUTANEOUS NERVE STIMULATION; WEIGHT GAIN;

AGED; AGED, 80 AND OVER; CENTRAL NERVOUS SYSTEM; DRUG PRESCRIPTIONS; DRUG UTILIZATION; FEMALE; GERIATRICS; HUMANS; HYPNOTICS AND SEDATIVES; INAPPROPRIATE PRESCRIBING; LONG-TERM CARE; MALE; MEDICATION ERRORS; MENTAL DISORDERS; PHYSICIAN'S PRACTICE PATTERNS; POLYPHARMACY; PSYCHOTROPIC DRUGS; UNITED STATES;

EID: 79957917004     PISSN: 07490690     EISSN: 18798853     Source Type: Journal    
DOI: 10.1016/j.cger.2011.01.003     Document Type: Review

References (67)

1. Haour F., Lang B. Sem Hop 1978, 54:1063-1070. [in French].
2. Pugh M.J., Hanlon J.T., Zeber J.E., et al. Assessing potentially inappropriate prescribing in the elderly Veterans Affairs population using the HEDIS 2006 quality measure. J Manag Care Pharm 2006, 12:537-545.
3. Beers M.H., Ouslander J.G., Rollingher I., et al. Explicit criteria for determining inappropriate medication use in nursing home residents. UCLA division of geriatric medicine. Arch Intern Med 1991, 151:1825-1832.
4. Beers M.H. Explicit criteria for determining potentially inappropriate medication use by the elderly. An update. Arch Intern Med 1997, 157:1531-1536.
5. Fick D.M., Cooper J.W., Wade W.E., et al. Updating the beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med 2003, 163:2716-2724.
6. Zhan C., Sangl J., Bierman A.S., et al. Potentially inappropriate medication use in the community-dwelling elderly: findings from the 1996 Medical Expenditure Panel Survey. JAMA 2001, 286:2823-2829.
7. National Committee for Quality Assurance HEDIS volume 2, technical specifications 2006, National Committee for Quality Assurance, Washington, DC.
8. Meeks T.W., Jeste D.V. Beyond the black box: what is the role for antipsychotics in dementia?. Curr Psychiatr 2008, 7:50-65.
9. Cotter V.T. The burden of dementia. Am J Manag Care 2007, 13(Suppl 8):S193-S197.
10. Jeste D.V., Meeks T.W., Kim D.S., et al. Research agenda for DSM-V: diagnostic categories and criteria for neuropsychiatric syndromes in dementia. J Geriatr Psychiatry Neurol 2006, 19:160-171.
11. Culp K.R., Cacchione P.Z. Nutritional status and delirium in long-term care elderly individuals. Appl Nurs Res 2008, 21:66-74.
12. Meeks T.W., Vahia I.V., Lavretsky H., et al. A tune in " a minor" can " b major": a review of epidemiology, illness course, and public health implications of subthreshold depression in older adults. J Affect Disord 2011, 129(1-3):126-142.
13. Fullerton C.A., McGuire T.G., Feng Z., et al. Trends in mental health admissions to nursing homes, 1999-2005. Psychiatr Serv 2009, 60:965-971.
14. Cheok A., Snowdon J., Miller R., et al. The prevalence of anxiety disorders in nursing homes. Int J Geriatr Psychiatry 1996, 11:405-410.
15. Smalbrugge M., Jongenelis L., Pot A.M., et al. Comorbidity of depression and anxiety in nursing home patients. Int J Geriatr Psychiatry 2005, 20:218-226.
16. Chutka D.S., Takahashi P.Y., Hoel R.W. Inappropriate medications for elderly patients. Mayo Clin Proc 2004, 79:122-139.
17. Macdiarmid S.A. Concomitant medications and possible side effects of antimuscarinic agents. Rev Urol 2008, 10:92-98.
18. Gallagher P.F., Barry P.J., Ryan C., et al. Inappropriate prescribing in an acutely ill population of elderly patients as determined by Beers' criteria. Age Ageing 2008, 37:96-101.
19. Alvarez P.A., Pahissa J. QT alterations in psychopharmacology: proven candidates and suspects. Curr Drug Saf 2010, 5:97-104.
20. Ray W.A., Chung C.P., Murray K.T., et al. Atypical antipsychotic drugs and the risk of sudden cardiac death. N Engl J Med 2009, 360:225-235.
21. Schneider L.S., Tariot P.N., Dagerman K.S., et al. Effectiveness of atypical antipsychotic drugs in patients with Alzheimer's disease. N Engl J Med 2006, 355:1525-1538.
22. Schneider L.S., Dagerman K., Insel P.S. Efficacy and adverse effects of atypical antipsychotics for dementia: meta-analysis of randomized, placebo-controlled trials. Am J Geriatr Psychiatry 2006, 14:191-210.
23. Livingston G., Johnston K., Katona C., et al. Systematic review of psychological approaches to the management of neuropsychiatric symptoms of dementia. Am J Psychiatry 2005, 162:1996-2021.
24. Ruths S., Straand J., Nygaard H.A., et al. Stopping antipsychotic drug therapy in demented nursing home patients: a randomized, placebo-controlled study-the Bergen District Nursing Home Study (BEDNURS). Int J Geriatr Psychiatry 2008, 23:889-895.
25. Westbury J., Jackson S., Gee P., et al. An effective approach to decrease antipsychotic and benzodiazepine use in nursing homes: the RedUSe project. Int Psychogeriatr 2010, 22:26-36.
26. Schmidt I., Claesson C.B., Westerholm B., et al. The impact of regular multidisciplinary team interventions on psychotropic prescribing in Swedish nursing homes. J Am Geriatr Soc 1998, 46:77-82.
27. Lieberman J.A., Stroup T.S., McEvoy J.P., et al. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med 2005, 353:1209-1223.
28. Jeste D.V. Tardive dyskinesia rates with atypical antipsychotics in older adults. J Clin Psychiatry 2004, 65(Suppl 9):21-24.
29. Jeste D.V., Lacro J.P., Bailey A., et al. Lower incidence of tardive dyskinesia with risperidone compared with haloperidol in older patients. J Am Geriatr Soc 1999, 47:716-719.
30. American Diabetes Association, American Psychiatric Association, American Association of Clinical Endocrinologists, et al. Consensus development conference on antipsychotic drugs and obesity and diabetes. Diabetes Care 2004, 27:596-601.
31. Borson S., Doane K. The impact of OBRA-87 on psychotropic drug prescribing in skilled nursing facilities. Psychiatr Serv 1997, 48:1289-1296.
32. Briesacher B.A., Soumerai S.B., Field T.S., et al. Medicare part D's exclusion of benzodiazepines and fracture risk in nursing homes. Arch Intern Med 2010, 170:693-698.
33. Ancoli-Israel S., Cooke J.R. Prevalence and comorbidity of insomnia and effect on functioning in elderly populations. J Am Geriatr Soc 2005, 53:S264-S271.
34. Avidan A.Y., Fries B.E., James M.L., et al. Insomnia and hypnotic use, recorded in the minimum data set, as predictors of falls and hip fractures in Michigan nursing homes. J Am Geriatr Soc 2005, 53:955-962.
35. Woolcott J.C., Richardson K.J., Wiens M.O., et al. Meta-analysis of the impact of 9 medication classes on falls in elderly persons. Arch Intern Med 2009, 169:1952-1960.
36. Hebert C., Delaney J.A., Hemmelgarn B., et al. Benzodiazepines and elderly drivers: a comparison of pharmacoepidemiological study designs. Pharmacoepidemiol Drug Saf 2007, 16:845-849.
37. Use of high risk medications in the elderly Available at:, Accessed September 28, 2010. http://www.ncqa.org/portals/0/hedisqm/HEDIS2008/Vol2/NDC/Table%2520DAE-A.doc.
38. Mets M.A., Volkerts E.R., Olivier B., et al. Effect of hypnotic drugs on body balance and standing steadiness. Sleep Med Rev 2010, 14:259-267.
39. Hwang T.J., Ni H.C., Chen H.C., et al. Risk predictors for hypnosedative-related complex sleep behaviors: a retrospective, cross-sectional pilot study. J Clin Psychiatry 2010, 71:1331-1335.
40. Toner L.C., Tsambiras B.M., Catalano G., et al. Central nervous system side effects associated with zolpidem treatment. Clin Neuropharmacol 2000, 23:54-58.
41. Meeks T.W., Wetherell J.L., Irwin M.R., et al. Complementary and alternative treatments for late-life depression, anxiety, and sleep disturbance: a review of randomized controlled trials. J Clin Psychiatry 2007, 68:1461-1471.
42. Zammit G., Wang-Weigand S., Rosenthal M., et al. Effect of ramelteon on middle-of-the-night balance in older adults with chronic insomnia. J Clin Sleep Med 2009, 5:34-40.
43. Tuya A.C. The management of insomnia in the older adult. Med Health R I 2007, 90:195-196.
44. Kramer D., Allgaier A.K., Fejtkova S., et al. Depression in nursing homes: prevalence, recognition, and treatment. Int J Psychiatry Med 2009, 39:345-358.
45. Ulfvarson J., Adami J., Wredling R., et al. Controlled withdrawal of selective serotonin reuptake inhibitor drugs in elderly patients in nursing homes with no indication of depression. Eur J Clin Pharmacol 2003, 59:735-740.
46. Stone M., Laughren T., Jones M.L., et al. Risk of suicidality in clinical trials of antidepressants in adults: analysis of proprietary data submitted to US Food and Drug Administration. BMJ 2009, 339:b2880.
47. Chemali Z., Chahine L.M., Fricchione G. The use of selective serotonin reuptake inhibitors in elderly patients. Harv Rev Psychiatry 2009, 17:242-253.
48. Kasper S., Lemming O.M., de Swart H. Escitalopram in the long-term treatment of major depressive disorder in elderly patients. Neuropsychobiology 2006, 54:152-159.
49. Weintraub D., Rosenberg P.B., Drye L.T., et al. Sertraline for the treatment of depression in Alzheimer disease: week-24 outcomes. Am J Geriatr Psychiatry 2010, 18:332-340.
50. Lyketsos C.G., DelCampo L., Steinberg M., et al. Treating depression in Alzheimer disease: efficacy and safety of sertraline therapy, and the benefits of depression reduction: the DIADS. Arch Gen Psychiatry 2003, 60:737-746.
51. Oslin D.W., Ten Have T.R., Streim J.E., et al. Probing the safety of medications in the frail elderly: evidence from a randomized clinical trial of sertraline and venlafaxine in depressed nursing home residents. J Clin Psychiatry 2003, 64:875-882.
52. Streim J.E., Oslin D.W., Katz I.R., et al. Drug treatment of depression in frail elderly nursing home residents. Am J Geriatr Psychiatry 2000, 8:150-159.
53. Burrows A.B., Salzman C., Satlin A., et al. A randomized, placebo-controlled trial of paroxetine in nursing home residents with non-major depression. Depress Anxiety 2002, 15:102-110.
54. Podsiadlo D., Richardson S. The timed " Up & Go": a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991, 39:142-148.
55. Herman A.D., Johnson T.M., Ritchie C.S., et al. Pain management interventions in the nursing home: a structured review of the literature. J Am Geriatr Soc 2009, 57:1258-1267.
56. Dwyer L.L., Han B., Woodwell D.A., et al. Polypharmacy in nursing home residents in the United States: results of the 2004 National Nursing Home Survey. Am J Geriatr Pharmacother 2010, 8:63-72.
57. American Geriatrics Society Panel on Pharmacological Management of Persistent Pain in Older Persons Pharmacological management of persistent pain in older persons. J Am Geriatr Soc 2009, 57:1331-1346.
58. Centers for Medicare and Medicaid Services/Survey and Certification Group 2010, Department of Health and Human Service, Baltimore (MD), Ref: S&C-09-22.
59. American Medical Directors Association Pain management clinical practice guideline 2009, AMDA, Columbia (MD).
60. Kisner C., Colby L.A. Therapeutic exercise, foundations and techniques 1996, FA Davis, Philadelphia. 3rd edition.
61. Johnson M., Martinson M. Efficacy of electrical nerve stimulation for chronic musculoskeletal pain: a meta-analysis of randomized controlled trials. Pain 2007, 130:157-165.
62. Ferrell B.A., Charette S.L. Pain management. Hazzard's geriatric medicine and gerontology 2009, McGraw-Hill, New York, p. 359-371. 6th edition. J.B. Halter, J.G. Ouslander, M.E. Tinetti (Eds.).
63. Won A.B., Lapane K.L., Vallow S., et al. Persistent nonmalignant pain and analgesic prescribing patterns in elderly nursing home residents. J Am Geriatr Soc 2004, 52:867-874.
64. Trescot A.M., Boswell M.V., Atluri S.L., et al. Opioid guidelines in the management of chronic non-cancer pain. Pain Physician 2006, 9:1-39.
65. Podichetty V.K., Mazanec D.J., Biscup R.S. Chronic non-malignant musculoskeletal pain in older adults: clinical issues and opioid intervention. Postgrad Med J 2003, 79:627-633.
66. Federation of State Medical Boards of the United States I Model policy for the use of controlled substances for the treatment of pain Available at:, Accessed September 15, 2010. http://www.fsmb.org/pdf/2004_grpol_Controlled_Substances.pdf.
67. Won A., Lapane K., Gambassi G., et al. Correlates and management of nonmalignant pain in the nursing home. SAGE Study Group. Systematic Assessment of Geriatric drug use via Epidemiology. J Am Geriatr Soc 1999, 47:936-942.