More Than A Third Of Nursing Home Patients Given Inappropriate Medications: Study

Many nursing home residents are regularly prescribed inappropriate medications, which may be unsafe and expose them to potentially serious side effects, according to the findings of new research.

In a study published this month in the Journal of General Internal Medicine, Researchers from the Dartmouth Centers for Health and Aging indicate that more than out of every three residents are prescribed at least one potentially inappropriate medication (PIM), and some are taking more.

Researchers focused on medication use among nursing home patients and the relationship between the use of potentially inappropriate medications and increased hospitalization risk. The study focused on data from 132 nursing home health agencies in the United States, including nearly 88,000 Medicare beneficiary patients starting home health nursing services between 2013 and 2014.

More than 30,000 patients, or about 34%, took at least one potentially inappropriate medication. Nearly 7% of patients, or about 6,000, took at least two or more potentially inappropriate medications.

The most common types of medications were painkillers and those affecting the brain or spinal cord, like drugs with anticholingeric properties, which block the neurotransmitter acetylcholine in the brain.

Taking unnecessary painkillers may lead to dependence and addiction. Anticholingeric drugs may cause people to overheat by decreasing the amount they sweat or lead to unconsciousness, or even death. They may also cause confusion, memory loss, worsening memory function or mental function, especially in people older than 65 years.

Researchers indicate that use of potentially inappropriate drugs, no matter the class of drugs, was associated with increased risk of hospitalization compared to non-use of potentially inappropriate medications. The increased risk ranged from 10% to 33%, depending on the type of drug.

Patients who used at least one potentially inappropriate medication had a 13% increased risk of being hospitalized, compared to patients using none. Similarly, those using two inappropriate medications had 21% greater risk of being hospitalized.

The risk of re-hospitalization after the initial hospitalization was also increased among patients who took one or more inappropriate medications.

The findings come amid long-standing concerns over the misuse of certain drugs meant to alter the moods and behaviors of nursing home patients, particularly those with dementia. Too often, nursing homes will give dementia patients unnecessary antipsychotics to make them less agitated, which increases their risk of nursing home falls and death. Use of these drugs in this manner is referred to as “chemical restraint” and is often considered a form of nursing home abuse.

“Given the high prevalence of PIM use and the association between PIMs and hospitalization risk, home health episodes represent opportunities to substantially reduce PIM use among older adults and prevent adverse outcomes,” the researchers concluded. “Efforts to address medication use during home health episodes, hospitalizations, and care transitions are justified.”