Tijdschrift voor Geneeskunde vol:70 issue:1 pages:11-17
Pharmacological treatment in nursing
homes: the rational use of six
At the yearly Winter meeting of the Belgian
Association for Gerontology & Geriatrics in
2013, the use of six medication groups in nursing
homes was studied. For elderly people
aged 80 years and older, an individual review
is needed, depending on factors like the
comorbidity, the functionality, the cognition, the
quality of life, the prognosis, the side effects
and the interactions.
The use of statins in the elderly is questioned.
The usefulness of acetylcholinesterase
inhibitors in nursing homes remains uncertain
from a scientific and an evidence-based point
of view. Although anticoagulation is as protective
in elderly persons with atrial fibrillation as in
younger people, it remains underused (ageism).
The use of an antihypertensive treatment for frail nursing home residents has to be scrutinized.
Antidepressants are prescribed more
frequently than should be expected based on
the epidemiology of a major depression, the
only indication with a proven effect. Proton
pump inhibitors have a superior effect compared
to H2 antagonists for a recommended
period of four to eight weeks. They should be
used in association with non-steroidal antiinflammatory
drugs (NSAIDs). More information
about the drugs used for people aged
80 years and older is needed.
An individual approach looking for a balance
between the advantages and the disadvantages
is required, but remains difficult due
to a lack of good evidence.