Research

Excessive polypharmacy and potentially inappropriate prescribing in 147 care homes: a cross-sectional study

Clare MacRae, David AG Henderson, Stewart W Mercer, Jenni Burton, Nicosha De Souza, Paula Grill, Charis Marwick and Bruce Guthrie
BJGP Open 2021; 5 (6): BJGPO.2021.0167. DOI: https://doi.org/10.3399/BJGPO.2021.0167

Article Figures & Data

Figures

Tables

  • Table 1. Resident and care home characteristics
    CharacteristicCategoryDispensed 0–9 drugs,n = 3024, n (%)aDispensed ≥10 drugs,n = 1444, n (%)aAll residents,n = 4468, n (%)a
    SexMale850 (28.1)422 (29.2)1272 (28.5)
    Female2174 (71.9)1022 (70.8)3196 (71.5)
    Age, yearsMean (SD)85.1 (8.3)84.6 (7.9)84.9 (8.1)
    Age group, years60–6468 (2.2)19 (1.3)87 (1.9)
    65–69101 (3.3)53 (3.7)154 (3.4)
    70–74184 (6.1)101 (7.0)285 (6.4)
    75–79317 (10.5)163 (11.3)480 (10.7)
    80–84580 (19.2)302 (20.9)882 (19.7)
    85–89765 (25.3)393 (27.2)1158 (25.9)
    90–94709 (23.4)288 (19.9)997 (22.3)
    ≥95300 (9.9)125 (8.7)425 (9.5)
    Drugs prescribedb Mean (SD)——7.8 (4.3)
    Median (IQR)——8 (3–13)
    Number of BNF chapters drugs prescribed fromMean (SD)3.4 (1.5)6.1 (1.3)4.2 (1.9)
    Dementia diagnosisNo dementia1506 (49.8)802 (55.5)2308 (51.7)
    Dementia1518 (50.2)642 (44.5)2160 (48.3)
    Care home typeNursing care
    (n = 71 homes)    		1858 (61.4)743 (51.5)2601 (58.2)
    Residential care
    (n = 76 homes)    		1166 (38.6)701 (48.5)1867 (41.8)
    Service sectorPrivate (n = 117)2625 (86.8)1124 (77.8)3749 (83.9)
    Local Authority (n = 19)246 (8.1)205 (14.2)451 (10.1)
    Third sector (n = 11)153 (5.1)115 (8.0)268 (6.0)
    Care home sizec Small (n = 41)417 (13.8)220 (15.2)637 (14.3)
    Medium (n = 68)1314 (43.5)714 (49.4)2028 (45.4)
    Large (n = 37)1290 (42.7)510 (35.3)1800 (40.3)
    RAD scoreLow (n = 102)1994 (65.9)1045 (72.4)3039 (68.0)
    Medium (n = 19)421 (13.9)175 (12.1)596 (13.3)
    High (n = 26)609 (20.1)224 (15.5)833 (18.6)
    Health boardTayside (n = 90)1871 (61.9)805 (55.7)2676 (59.9)
    Fife (n = 57)1153 (38.1)639 (44.3)1792 (40.1)

    • aUnless otherwise stated. bDistribution normal overall but skewed in groups so SD and IRQ not reported for groups. Overall distribution shown in Supplementary Figure S1. cMissing data for one care home. BNF = British National Formulary. IQR = interquartile range. RAD = Risk Assessment Document. SD = standard deviation.

  • Table 2. Number of care home residents, mean number of medicines, and most frequent drug class prescribed, by BNF chapter
    Most frequent drug class prescribed
    BNF chapterPatients prescribed medicine, n (%)Medications prescribed, mean (SD)First (%)
    		Second (%)
    		Third (%)
    		Fourth (%)
    		Fifth (%)
    1. Gastrointestinal System2991 (66.9)1.63 (0.84)Osmotic laxatives (36.3)Proton pump inhibitors(35.8)Stimulant laxatives (17.7)H2 receptor agonists (5.2)Compound alginates and proprietary antacids (3.9)
    2. Cardiovascular System2883 (64.5)2.32 (1.3)Statins (27.3)Loop diuretics (20.6)Aspirin (17.8)Beta-adrenoceptor blocking drugs (17.5)Clopidogrel (14.4)
    3. Respiratory System684 (15.3)1.79 (1.15)Short acting beta2 adrenoceptor agonists (6.1)Inhaled corticosteroids (5.6)Non-sedating antihistamines (4.9)Antimuscarinic bronchodilators (3.3)Sedating antihistamines (1.7)
    4. Central Nervous System3687 (82.5)2.39 (1.37)Paracetamol (47.2)Drugs for dementia (26.4)SSRI antidepressants (19.0)Other antidepressants (16.7)Opioid analgesics (16.3)
    5. Infections1402 (31.4)1.41 (0.74)Broad spectrum penicillins (11.4)Sulfonamides and trimethoprim (8.1)Nitrofurantoin (6.2)Penicillinase-resistant penicillins (4.2)Tetracyclines (4.1)
    6. Endocrine System1658 (37.1)1.26 (0.56)Thyroid hormones (19.2)Bisphosphonates and drugs affecting bone metabolism (10.1)Biguanides (5.3)Treatment corticosteroids (3.4)Male sex hormones and antagonists (3.3)
    7. Obstetrics, Gynaecology and Urinary-Tract Disorders404 (9.0)1.07 (0.27)Drugs for urinary frequency, enuresis, incontinence (5.3)Drugs for urinary retention (3.4)Vaginal and vulval infections (0.5)Topical hormone replacement therapy(0.4)Drugs used in urological pain (0.1)
    8. Malignant Disease and Immunosuppression83 (1.9)1 (0)Hormone antagonists (1.5)Azathioprine (0.2)Other antineoplastic (0.1)Mycophenolate (<0.1)Ciclosporin (<0.1)
    9. Nutrition and Blood2011 (45.0)1.98 (0.78)Vitamin D (35.6)Oral iron (10.2)Drugs used in megaloblastic anaemias (9.9)Fluoride (1.1)Calcium supplements (0.5)
    10. Musculoskeletal and Joint Diseases692 (15.5)1.09 (0.31)Rubefacients, topical NSAIDs, capsaicin, and poultices (11.7)Gout and cytotoxic induced hyperuricaemia (2.4)Skeletal muscle relaxants(1.5)Methotrexate (0.4)Nonselective NSAIDs (0.4)
    11. Eye595 (13.3)1.46 (0.82)Tear deficiency, ocular lubricants and astringents (7.6)Glaucoma: prostaglandinanalogues (3.8)Antibacterial eye preparations (2.2)Glaucoma: other (1.4)Glaucoma: beta-blockers (0.9)
    12. Ear, Nose and Oropharynx133 (3.0)1.06 (0.24)Nasal allergy, topical antihistamines and cromoglicate (1.6)Drugs for oral ulceration and inflammation (0.5)Otitis externa (0.3)Oropharyngeal anti-infective drugs (0.3)Topical nasal decongestants (0.2)
    13. Skin1747 (39.1)1.65 (0.97)Emollients (23.1)Barrier preparations (15.8)Topical corticosteroids (9.0)Antifungal skin preparations (2.6)Shampoos and other preparations for scalp and/or hair (1.7)

    • BNF = British National Formulary. SD = standard deviation. SSRI = selective-serotonin reuptake inhibitors. NSAIDs = non-steroidal anti-inflammatory drugs.

  • Table 3. Multilevel logistic regression analysis of excessive polypharmacy in care home residents
    CharacteristicCategoryDispensed ≥10 drugs,n = 1444, n (%)OR univariable(95% CI)b,cOR multivariable(95% CI)c,d
    Age group, years60–6419 (21.8)RefRef
    65–6953 (34.4)1.76 (0.94 to 3.29)1.80 (0.96 to 3.38)
    70–74101 (35.4)1.79 (1.00 to 3.21)1.86 (1.04 to 3.34)
    75–79163 (34.0)1.67 (0.96 to 2.94)1.73 (0.98 to 3.03)
    80–84302 (34.2)1.65 (0.96 to 2.85)1.75 (1.01 to 3.02)
    85–89393 (33.9)1.60 (0.93 to 2.75)1.66 (0.97 to 2.87)
    90–94288 (28.9)1.18 (0.68 to 2.04)1.19 (0.69 to 2.07)
    ≥95125 (29.4)1.14 (0.64 to 2.01)1.08 (0.61 to 1.92)
    SexMale422 (33.2)Ref–
    Female1022 (32.0)0.89 (0.77 to 1.03)–
    Dementia statusNo dementia802 (34.7)RefRef
    Dementia642 (29.7)0.78 (0.68 to 0.89)0.73 (0.64 to 0.84)
    Care home typeNursing743 (28.6)RefRef
    Residential701 (37.5)1.49 (1.19 to 1.85)1.50 (1.19 to 1.88)
    RAD scoreLow1045 (34.4)RefRef
    Medium175 (29.4)0.75 (0.54 to 1.06)0.72 (0.52 to 0.99)
    High224 (26.9)0.69 (0.51 to 0.93)0.77 (0.56 to 1.04)
    NHS health boardTayside805 (30.1)RefRef
    Fife639 (35.7)1.24 (0.99 to 1.57)1.37 (1.09 to 1.71)
    Intraclass correlation coefficient, % (95% CI)——8.9 (5.9 to 11.6)Null model7.1 (4.2 to 9.5)Adjusted model

    • aWithin category %. bNumber of groups = 147; residents in all models = 4468. Service sector and care home size not fitted in models as collinear with care home status. cUnless otherwise stated. dC-statistic = 0.685. – = variable not fitted. RAD = Risk Assessment Document.

Supplementary Data

  • McR_BJGPO.2021.0167_Supp.pdf -

    Supplementary material is not copyedited or typeset, and is published as supplied by the author(s). The author(s) retain(s) responsibility for its accuracy.
Back to top

In this issue

BJGP Open
Vol. 5, Issue 6
January 2021
Download PDF
Download PowerPoint
Email Article
Citation Tools
Excessive polypharmacy and potentially inappropriate prescribing in 147 care homes: a cross-sectional study
Clare MacRae, David AG Henderson, Stewart W Mercer, Jenni Burton, Nicosha De Souza, Paula Grill, Charis Marwick, Bruce Guthrie
BJGP Open 2021; 5 (6): BJGPO.2021.0167. DOI: 10.3399/BJGPO.2021.0167
del.icio.us logo Facebook logo Mendeley logo Bluesky logo

Jump to section

Keywords

Intended for Healthcare Professionals
 
 

British Journal of General Practice