Author:

Keywords:

Nursing, Elderly, Polypharmacy, Science & Technology, Life Sciences & Biomedicine, 1110 Nursing, 4204 Midwifery, 4205 Nursing

Abstract:

Polypharmacy in elderly in nursing homes: how nurses can contribute to deprescribing medications. Background and introduction Polypharmacy is common among the elderly and is known as a risk factor for important morbidity and mortality. Guidelines on polypharmacy are now often developed for physicians. They appear beneficial in terms of reducing inappropriate prescribing. Numerous medications are prescribed at the request of nurses according to the corresponding nursing problem, while non-pharmacological interventions are available but not applied by a lack of implementation strategies. Aim The aim of the study was to determine nurse-related prescribing patterns of medications in nursing homes. Materials and methods A cross-sectional study in a consortium of 7 Flemish nursing homes was set up in April 2015. Demographic characteristics, Katzscores, the number and classes of medications, rate of polypharmacy >5 drugs (per day) and polypharmacy >10 drugs (per day) were recorded. Teardrops, vitamins, minerals and suppletion products were not included in the rate of polypharmacy. Results Medication reports of 458 residents (response rate 57%) were included. The mean age was 86 years and 73% of the residents were female and the mean age was 86 years. A total of 407 different medications were prescribed by 164 primary care physicians. The mean daily number of medications was 6,8 per person (range 0 – 19). 73% of the residents took 5 or more medications a day, 50% between 5 - 9 medications and 23% took 10 medications or more. For 44% of the residents benzodiazepines or Z-medications were prescribed, 42% received antidepressiva, 40% laxativa, 25% pain medications and 22% anti-psychotics. Discussion en conclusion The prevalence of polypharmacy in elderly in nursing homes is still high. In contrary the percentage of residents receiving pain medications is lower than in other studies. It’s unclear if this can be explained by a more appropriate way of prescribing or by a lack of measuring pain in elderly by care givers. Nurses can have an important role in reducing polypharmacy in elderly in nursing homes by implementing alternative approaches for reduced quality of sleep, symptoms of depression, obstipation and changed behavior. Future longitudinal studies should focus on the effect of these alternative approaches on prescribing patterns of medications .