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Older Adults in Nursing Homes and Assisted Living Are Vulnerable to Adverse Drug-Drug Interactions

Older adults, especially those residing in assisted living facilities, are highly vulnerable to dangerous drug-drug interactions (DDIs) because of comorbidities and the prescription of a higher number of drugs.  These serious DDIs can result in adverse clinical outcomes and should be avoided at all times.  This issue has been receiving increasing attention in the elderly population due to multiple medication use being more common in the management of diseases. Studies that have examined DDIs in hospital and outpatient settings, as well as drug registers, report DDI prevalence rates of up to 26%, whereas studies exploring DDIs in community-settings reveal a prevalence as high as 63%.  Prevalence rates in hospital settings are also varied, including wards, which have a rate of 57.8%, and emergency departments, which have a rate of 0.7%.

A recent study explored the severity of DDIs among residents in long-term care facilities (4.8%), who are most vulnerable to the prescription of multiple drugs and, thus, also to DDIs.  Researchers have found that common risk factors significantly related to DDIs are increasing age, female gender, the use of a high variety of drugs, and cardiovascular diseases.  Drugs that have been most frequently associated with DDIs are anticoagulants, ACE inhibitors, potassium sparing-diuretics, carbamazepine, and potassium supplements.  Older adults who experience a DDI are at high risk of hospitalization and higher healthcare expenses.

With greater education and more effective interventions, DDIs can be anticipated and avoided.  Substantial research has shown that physicians are only trained to identify a minority of DDIs. So far, little research has been done exploring the clinical outcomes of DDIs in vulnerable, frail older adults who are prone to taking a large variety of drugs. Therefore, a recent study aimed to identify the prevalence of DDIs among the elderly population residing in long-term care facilities, their associated characteristics, and to compare the mortality of elderly residents with and without DDIs.

The study found that for residents in assisted living facilities, one out of every 17 used an inappropriate combination of drugs that made them at risk for DDIs.  Moreover, patients prescribed more drugs or with arthritis were related to higher DDI combinations.  The study’s results showed that a greater number of prescribed drugs significantly raised the risk of DDIs.  Cardiovascular diseases and stroke were also related to a higher risk of DDIs.

The study concludes that approximately 6% of frail elderly patients in long-term care facilities were exposed to hazardous DDIs. This exposure was a consequence of using a high variety of drugs, but absent of all-cause mortality or with the degree of psychological wellbeing.

The study shows that physicians who are responsible for patients residing in assisted living or nursing home facilities, such as those in Diamond Bar and Downey, California, should be extremely careful when prescribing drugs, especially when prescribing a large number of them.  Elderly residents who are frail and suffer from several diseases are particularly at risk of negative drug-drug interactions.  If you or someone you care about has been a victim of elder abuse or neglect in a long-term care facility, please reach out to us today.