The prescription of potentially inappropriate medications to older adults is known to be highly prevalent in the United States, estimating from 12% for community-living seniors to 40% for those dwelling in nursing homes (NHs). When prescribed drugs are clearly indicated, founded on scientific evidence, and are well tolerated, medication use is considered beneficial. Medications that are inappropriately prescribed often lead to negative health consequences. Furthermore, age-related physiological changes may influence the change of pharmacokinetic and pharmacodynamics responses to medications, further decreasing the tolerability of many medications in older adults.
It is well known that Alzheimer disease (AD) and other forms of dementia are very common among older adults. These progressive and terminal illnesses, of which AD is the most common form, cause severe impairment of mental function. Negative effects from medication may occur when patients with dementia undergo a range of behavioral and psychological symptoms of dementia in accordance with other causes, including unaddressed physical health complaints, depression, unidentified pain, psychosocial factors, and physical environmental factors. In addition, those with severe dementia may experience progressive difficulty eating and swallowing, and find verbalizing symptoms and adverse effects challenging, making medication therapy potentially more hazardous. Thus, prescription management should be revised on a regular basis, and medications that were previously prescribed for chronic comorbidities may have the possibility of being discontinued to both mitigate adverse events and enhance comfort and symptom control.
A recent study aimed to determine the method in identifying inappropriate medications for NH residents with severe dementia and explore interventions likely to improve medication use among these older adults. The study found that in order to improve the use of medication prescribed to NH residents with severe dementia, the intervention should aim to include NH health care professionals. More specifically, educational programs or training, medication review, and case conferencing or multidisciplinary team meetings should be integrated into the intervention to reduce inappropriate prescriptions given to NH residents. The study showed that successful interventions were managed by physicians, by pharmacists, or by multidisciplinary teams. The results also showed that educational methods improve prescribing appropriateness. Overall, interactive approaches with direct feedback were observed to be the most effective.
Nursing homes should strive to maintain or improve the use of medication among vulnerable residents. Their approaches should be founded on good-quality evidence, integrate different interdisciplinary strategies, and take into consideration concerns and opinions of all parties concerned; specifically, patients and their family members, as well as care providers including general and specialized physicians.