Prevalence and Factors Associated With Polypharmacy in Long-Term Care Facilities: A Systematic Review

Journal of the American Medical Directors Association

Volumn 16, Issue 6, 2015, Pages 535.e1-535.e12

  Jokanovic, Natali ^a,b   Tan, Edwin C K ^a   Dooley, Michael J ^a,b   Kirkpatrick, Carl M ^a   Bell, J Simon ^a  

^a MONASH UNIVERSITY   (Australia)

^b ALFRED HOSPITAL   (Australia)

Author keywords

Aged; Homes for the aged; Long term care; Nursing homes; Polypharmacy

Indexed keywords

CARDIOVASCULAR DISEASE; CHARLSON COMORBIDITY INDEX; COGNITIVE DEFECT; COMORBIDITY; DIZZINESS; DYSPNEA; ENDOCRINE DISEASE; GASTROINTESTINAL SYMPTOM; HOSPITAL DISCHARGE; HUMAN; LENGTH OF STAY; LONG TERM CARE; METABOLIC DISORDER; MOTOR DYSFUNCTION; NEUROLOGIC DISEASE; NURSING HOME; PAIN; POLYPHARMACY; PRESCRIPTION; PREVALENCE; REVIEW; SYSTEMATIC REVIEW;

HUMANS; LONG-TERM CARE; POLYPHARMACY; PREVALENCE;

EID: 84929956013     PISSN: 15258610     EISSN: 15389375     Source Type: Journal    
DOI: 10.1016/j.jamda.2015.03.003     Document Type: Review

References (80)

1. Islam M.M., Valderas J.M., Yen L., et al. Multimorbidity and comorbidity of chronic diseases among the senior Australians: Prevalence and patterns. PLoS One 2014, 9:e83783.
2. Hung W.W., Ross J.S., Boockvar K.S., Siu A.L. Recent trends in chronic disease, impairment and disability among older adults in the United States. BMC Geriatr 2011, 11:47.
3. Fulton M.M., Allen E.R. Polypharmacy in the elderly: A literature review. JAm Acad Nurse Pract 2005, 17:123-132.
4. Shah B.M., Hajjar E.R. Polypharmacy, adverse drug reactions, and geriatric syndromes. Clin Geriatr Med 2012, 28:173-186.
5. Grabowski D.C., Stevenson D.G., Cornell P.Y. Assisted living expansion and the market for nursing home care. Health Serv Res 2012, 47:2296-2315.
6. Gorard D.A. Escalating polypharmacy. QJM 2006, 99:797-800.
7. Duerden M, Avery T, Payne R. Polypharmacy and medicines optimisation. Making it safe and sound. The King's Fund, 2013. Available at: . Accessed November 27, 2014. http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/polypharmacy-and-medicines-optimisation-kingsfund-nov13.pdf.
8. Lee W.C., Sumaya C.V. Geriatric workforce capacity: A pending crisis for nursing home residents. Front Public Health 2013, 1:24.
9. Mitty E. Medication management in assisted living: A national survey of policies and practices. JAm Med Dir Assoc 2009, 10:107-114.
10. Maher R.L., Hanlon J., Hajjar E.R. Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf 2014, 13:57-65.
11. Tamura B.K., Bell C.L., Inaba M., Masaki K.H. Outcomes of polypharmacy in nursing home residents. Clin Geriatr Med 2012, 28:217-236.
12. Kongkaew C., Noyce P.R., Ashcroft D.M. Hospital admissions associated with adverse drug reactions: A systematic review of prospective observational studies. Ann Pharmacother 2008, 42:1017-1025.
13. Bourgeois F.T., Shannon M.W., Valim C., Mandl K.D. Adverse drug events in the outpatient setting: An 11-year national analysis. Pharmacoepidemiol Drug Saf 2010, 19:901-910.
14. Damian J., Pastor-Barriuso R., Valderrama-Gama E., de Pedro-Cuesta J. Factors associated with falls among older adults living in institutions. BMC Geriatr 2013, 13:6.
15. Vu M.Q., Weintraub N., Rubenstein L.Z. Falls in the nursing home: Are they preventable?. JAm Med Dir Assoc 2006, 7:S53-S58. 52.
16. Hovstadius B., Petersson G. The impact of increasing polypharmacy on prescribed drug expenditure-a register-based study in Sweden 2005-2009. Health Policy 2013, 109:166-174.
17. Cherubini A., Eusebi P., Dell'Aquila G., et al. Predictors of hospitalization in Italian nursing home residents: The U.L.I.S.S.E. project. JAm Med Dir Assoc 2012, 13:84.e5-84.e10.
18. Reviewers' manual The Joanna Briggs Institute, Available at:, Accessed October 7, 2014. http://joannabriggs.org/assets/docs/sumari/ReviewersManual-2014.pdf.
19. Aguilar E.A., Ashraf H., Frontini M., et al. An analysis of chronic kidney disease risk factors in a Louisiana nursing home population: A cross-sectional study. JLa State Med Soc 2013, 165:260-263. 265-267.
20. Balogun S., Preston M., Evans J. Potentially inappropriate medications in nursing homes: Sources and correlates. The Internet Journal of Geriatrics and Gerontology 2004, 2.
21. Dwyer L.L., Han B., Woodwell D.A., Rechtsteiner E.A. 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.
22. Field T.S., Gurwitz J.H., Avorn J., et al. Risk factors for adverse drug events among nursing home residents. Arch Intern Med 2001, 161:1629-1634.
23. Gellad W.F., Aspinall S.L., Handler S.M., et al. Use of antipsychotics among older residents in VA nursing homes. Med Care 2012, 50:954-960.
24. Hanlon J.T., Wang X., Good C.B., et al. Racial differences in medication use among older, long-stay Veterans Affairs nursing home care unit patients. Consult Pharm 2009, 24:439-446.
25. Holmes H.M., Sachs G.A., Shega J.W., et al. Integrating palliative medicine into the care of persons with advanced dementia: Identifying appropriate medication use. JAm Geriatr Soc 2008, 56:1306-1311.
26. Jervis L.L., Shore J., Hutt E., Manson S.M. Suboptimal pharmacotherapy in a tribal nursing home. JAm Med Dir Assoc 2007, 8:1-7.
27. Lau D.T., Kasper J.D., Potter D.E., Lyles A. Potentially inappropriate medication prescriptions among elderly nursing home residents: Their scope and associated resident and facility characteristics. Health Serv Res 2004, 39:1257-1276.
28. Monroe T., Carter M., Parish A. Acase study using the Beers list criteria to compare prescribing by family practitioners and geriatric specialists in a rural nursing home. Geriatr Nurs 2011, 32:350-356.
29. Nguyen J.K., Fouts M.M., Kotabe S.E., Lo E. Polypharmacy as a risk factor for adverse drug reactions in geriatric nursing home residents. Am J Geriatr Pharmacother 2006, 4:36-41.
30. Perri Iii M., Menon A.M., Deshpande A.D., et al. Adverse outcomes associated with inappropriate drug use in nursing homes. Ann Pharmacother 2005, 39:405-411.
31. Sawyer P., Lillis J.P., Bodner E.V., Allman R.M. Substantial daily pain among nursing home residents. JAm Med Dir Assoc 2007, 8:158-165.
32. Tamura B.K., Bell C.L., Lubimir K., et al. Physician intervention for medication reduction in a nursing home: The polypharmacy outcomes project. JAm Med Dir Assoc 2011, 12:326-330.
33. Kojima G., Bell C., Tamura B., et al. Reducing cost by reducing polypharmacy: The polypharmacy outcomes project. JAm Med Dir Assoc 2012, 13:818.e11-818.e15.
34. Lane H., Zordan R.D., Weiland T.J., Philip J. Hospitalisation of high-care residents of aged care facilities: Are goals of care discussed?. Intern Med J 2013, 43:144-149.
35. Moore K.J., Doyle C.J., Dunning T.L., et al. Public sector residential aged care: Identifying novel associations between quality indicators and other demographic and health-related factors. Aust Health Rev 2014, 38:325-331.
36. Somers M., Rose E., Simmonds D., et al. Quality use of medicines in residential aged care. Aust Fam Physician 2010, 39:413-416.
37. Stafford A.C., Alswayan M.S., Tenni P.C. Inappropriate prescribing in older residents of Australian care homes. JClin Pharm Ther 2011, 36:33-44.
38. Wilson N.M., Hilmer S.N., March L.M., et al. Associations between drug burden index and falls in older people in residential aged care. JAm Geriatr Soc 2011, 59:875-880.
39. Baranzini F., Diurni M., Ceccon F., et al. Fall-related injuries in a nursing home setting: Is polypharmacy a risk factor?. BMC Health Serv Res 2009, 9:228.
40. Finkers F., Maring J.G., Boersma F., Taxis K. Astudy of medication reviews to identify drug-related problems of polypharmacy patients in the Dutch nursing home setting. JClin Pharm Ther 2007, 32:469-476.
41. Koopmans R.T., van der Borgh J.P., Bor J.H., Hekster Y.A. Increase in drug use after admission to Dutch nursing homes. Pharm World Sci 2003, 25:30-34.
42. Bergman A., Olsson J., Carlsten A., et al. Evaluation of the quality of drug therapy among elderly patients in nursing homes. Scand J Prim Health Care 2007, 25:9-14.
43. Olsson I.N., Curman B., Engfeldt P. Patient focused drug surveillance of elderly patients in nursing homes. Pharmacoepidemiol Drug Saf 2010, 19:150-157.
44. Gadsby R., Galloway M., Barker P., Sinclair A. Prescribed medicines for elderly frail people with diabetes resident in nursing homes-issues of polypharmacy and medication costs. Diabet Med 2012, 29:136-139.
45. Whitney J., Close J.C.T., Lord S.R., Jackson S.H.D. Identification of high risk fallers among older people living in residential care facilities: A simple screen based on easily collectable measures. Arch Gerontol Geriatr 2012, 55:690-695.
46. Honney K., Trepte N.J.B., Parker R.A., et al. Characteristics and determinants of survival in oldest old nursing home residents admitted to hospital with an acute illness compared to their younger counterparts. Aging Clin Exp Res 2014, 26:153-160.
47. Terassi M., Rissardo L.K., Peixoto J.S., et al. Prevalence of drug use in institutionalized elderly people: A descriptive study. Online Braz J Nurs 2012, 11:26-37.
48. Bronskill S.E., Gill S.S., Paterson J.M., et al. Exploring variation in rates of polypharmacy across long term care homes. JAm Med Dir Assoc 2012, 13:309.e15-309.e21.
49. Hosia-Randell H.M., Muurinen S.M., Pitkälä K.H. Exposure to potentially inappropriate drugs and drug-drug interactions in elderly nursing home residents in Helsinki, Finland: A cross-sectional study. Drugs Aging 2008, 25:683-692.
50. Sun X.L., Dickinson J.A. Prevalence of drug use among the elderly in a local institutional home. Hong Kong Practitioner 2003, 25:243-248.
51. Cusack S., Day M.R., Wills T., Coffey A. Older people and laxative use: Comparison between community and long-term care settings. Br J Nurs 2012, 21:711-717.
52. Beloosesky Y., Nenaydenko O., Gross Nevo R.F., et al. Rates, variability, and associated factors of polypharmacy in nursing home patients. Clin Interv Aging 2013, 8:1585-1590.
53. Al Aqqad S.M.H., Chen L.L., Shafie A.A., et al. The use of potentially inappropriate medications and changes in quality of life among older nursing home residents. Clin Interv Aging 2014, 9:201-207.
54. Michalik C., Matusik P., Nowak J., et al. Heart failure, comorbidities, and polypharmacy among elderly nursing home residents. Pol Arch Med Wewn 2013, 123:170-175.
55. Advinha A.M., De Oliveira-Martins S., Mateus V., et al. Medication regimen complexity in institutionalized elderly people in an aging society. Int J Clin Pharm 2014, 36:750-756.
56. Mamun K., Lien C.T.C., Goh-Tan C.Y.E., Ang W.S.T. Polypharmacy and inappropriate medication use in Singapore nursing homes. Ann Acad Med Singapore 2004, 33:49-52.
57. Wang Y.C., Lin F.G., Yu C.P., et al. Depression as a predictor of falls amongst institutionalized elders. Aging Ment Health 2012, 16:763-770.
58. Sancar M., Yalcin Mutlu B., Okuyan B., Vehbi Izzettin F. Determination ofgeriatric patients' drug profile and identify their pharmaceutical care requirements by determining potential risk factors. Eur Geriatr Med 2011, 2:280-283.
59. Onder G., Liperoti R., Fialova D., et al. Polypharmacy in nursing home in Europe: Results from the SHELTER study. JGerontol A Biol Sci Med Sci 2012, 67:698-704.
60. Onder G., Liperoti R., Foebel A., et al. Polypharmacy and mortality among nursing home residents with advanced cognitive impairment: Results from the SHELTER study. JAm Med Dir Assoc 2013, 14:450.e7-450.e12.
61. Vetrano D.L., Tosato M., Colloca G., et al. Polypharmacy in nursing home residents with severe cognitive impairment: Results from the SHELTER study. Alzheimers Dement 2013, 9:587-593.
62. Moore K.L., Boscardin W.J., Steinman M.A., Schwartz J.B. Patterns of chronic co-morbid medical conditions in older residents of U.S. nursing homes: Differences between the sexes and across the agespan. JNutr Health Aging 2014, 18:429-436.
63. Yancy C.W., Jessup M., Bozkurt B., et al. 2013 ACCF/AHA guideline for the management of heart failure: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. JAm Coll Cardiol 2013, 62:e147-e239.
64. National Health Foundation of Australia and the Cardiac Society of Australia and New Zealand (Chronic Heart Failure Guidelines Expert Writing Panel). Guidelines for the prevention, detection and management of chronic heart failure in Australia. 2011. Available at: . Accessed October 28, 2014. http://www.heartfoundation.org.au/SiteCollectionDocuments/Chronic_Heart_Failure_Guidelines_2011.pdf.
65. National Heart Foundation of Australia (National Blood Pressure and Vascular Disease Advisory Committee). Guide to management of hypertension 2008. 2010. Available at: . Accessed October 28, 2014. http://www.heartfoundation.org.au/SiteCollectionDocuments/HypertensionGuidelines2008to2010Update.pdf.
66. Goeres L.M., Williams C.D., Eckstrom E., Lee D.S. Pharmacotherapy for hypertension in older adults: A systematic review. Drugs Aging 2014, 31:897-910.
67. Abdelhafiz A.H., Sinclair A.J. Management of type 2 diabetes in older people. Diabetes Ther 2013, 4:13-26.
68. Kuijpers M.A., van Marum R.J., Egberts A.C., Jansen P.A. Relationship between polypharmacy and underprescribing. Br J Clin Pharmacol 2008, 65:130-133.
69. Holmes H.M. Rational prescribing for patients with a reduced life expectancy. Clin Pharmacol Ther 2009, 85:103-107.
70. Tjia J., Velten S.J., Parsons C., et al. Studies to reduce unnecessary medication use in frail older adults: A systematic review. Drugs Aging 2013, 30:285-307.
71. Weston A.L., Weinstein A.M., Barton C., Yaffe K. Potentially inappropriate medication use in older adults with mild cognitive impairment. JGerontol A Biol Sci Med Sci 2010, 65:318-321.
72. Huey E.D., Taylor J.L., Luu P., et al. Factors associated with use of medications with potential to impair cognition or cholinesterase inhibitors among Alzheimer's disease patients. Alzheimers Dement 2006, 2:314-321.
73. Onder G., Gambassi G., Scales C.J., et al. Adverse drug reactions and cognitive function among hospitalized older adults. Eur J Clin Pharmacol 2002, 58:371-377.
74. Tjia J., Briesacher B.A., Peterson D., et al. Use of medications of questionable benefit in advanced dementia. JAMA Intern Med 2014, 174:1763-1771.
75. Tricco A.C., Soobiah C., Berliner S., et al. Efficacy and safety of cognitive enhancers for patients with mild cognitive impairment: A systematic review and meta-analysis. CMAJ 2013, 185:1393-1401.
76. de Lange E., Verhaak P.F., van der Meer K. Prevalence, presentation and prognosis of delirium in older people in the population, at home and in long term care: A review. Int J Geriatr Psychiatry 2013, 28:127-134.
77. Hein C., Forgues A., Piau A., et al. Impact of polypharmacy on occurrence of delirium in elderly emergency patients. JAm Med Dir Assoc 2014, 15:850.e11-850.e15.
78. Elmståhl S., Linder H. Polypharmacy and inappropriate drug use among older people-A systematic review. Healthy Aging Clin Care Elder 2013, 5:1-8.
79. Chu L., Schnelle J.F., Osterweil D. Prescription analgesic and antidepressant utilization and cost among elderly Medicaid beneficiaries before and after nursing home admission. JAm Med Dir Assoc 2004, 5:75-81.
80. Hughes C.M., Lapane K., Watson M.C., Davies H.T. Does organisational culture influence prescribing in care homes for older people? A new direction for research. Drugs Aging 2007, 24:81-93.