Abstract
Purpose
Pharmacoepidemiological studies aimed to distinguish drug use in nursing home (NH) residents with and without dementia could be useful to target specific interventions to improve prescribing. This multicenter retrospective study aimed (i) to describe drug therapy in a large sample of NH residents according to the diagnosis of dementia, and (ii) to record the most frequent potentially severe drug-drug interactions.
Methods
This study was conducted in a sample of Italian long-term care NHs. Drug prescription information, diseases, and socio-demographic characteristics of NH residents were collected at three different times during 2018.
Results
The mean number of drugs was significantly higher in NH residents without dementia than in those with (p = 0.05). Antipsychotics, laxatives, benzodiazepines, antiplatelets, and proton pump inhibitors (PPIs) were most commonly prescribed in patients with dementia, and PPIs, benzodiazepines, and laxatives in those without. The prevalence of patients with potentially severe drug-drug interactions was higher among those without dementia, 1216 (64.7%) and 518 (74.2%, p < 0.0001). There were significant differences between the mean numbers of drugs prescribed in individual NH after adjusting the analysis for age, sex, and mean Charlson index, the estimated mean number of drugs prescribed (± standard error) ranging from 5.1 (± 0.3) to 9.3 (± 0.3) in patients with dementia (p < 0.0001) and from 6.0 (± 0.7) to 10.9 (± 0.50) in those without dementia (p < 0.0001). Chronic use of psychotropic drugs was common in NH residents with and without dementia.
Conclusions
The wide variability between NHs in drug prescriptions and potentially inappropriate prescribing suggests the need to recommend a standardized approach to medication review of psychotropic drugs, antiulcer, laxatives, and antiplatelets in this complex and vulnerable population.
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Acknowledgments
The authors are very grateful to Korian Italy for the possibility of conducting the study. Korian Italy had no role in the conception and design of the study, data analysis and interpretation, the preparation and writing of the report, or the decision to submit the manuscript for publication. All authors critically revised the manuscript and approved its final version. We are grateful to J.D. Baggott for language editing.
Authors’ individual contributions
All Authors participated in drafting of the manuscript or critical revision of the manuscript for important intellectual content and provided approval of the final submitted version. Individual contributions are as follows: LP designed the study, interpreted data, and wrote the manuscript; AN, MT, and LC did and interpreted statistical analyses; AN and AI made the final critical revision for important intellectual contents. All authors approved the final version of the paper.
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Data collection complied fully with Italian law on personal data protection, and the study was approved by the ethics committee of the IRCCS Carlo Besta Foundation.
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Pasina, L., Novella, A., Cortesi, L. et al. Drug prescriptions in nursing home residents: an Italian multicenter observational study. Eur J Clin Pharmacol 76, 1011–1019 (2020). https://doi.org/10.1007/s00228-020-02871-7
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DOI: https://doi.org/10.1007/s00228-020-02871-7