Long-term care residents with dementia often overprescribed drugs, study finds

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Proposed Medicare rules would tighten CMS oversight of nursing home prescriptions
Proposed Medicare rules would tighten CMS oversight of nursing home prescriptions

Residents of long-term care facilities with dementia are often overprescribed drugs that can cancel out the effects of their dementia medications, according to a new study

Researchers at the University of Toronto and Toronto's Institute for Clinical Evaluative Sciences analyzed data from seniors living in long-term care facilities, as well as community-dwelling seniors, to explore the link between seniors taking both cholinesterase inhibitors for dementia and drugs with anticholinergic effects. The study also looked at the association between seniors' drug burdens — the cumulative effect of using multiple anticholinergic drugs — and the number of physicians they see each year.

Full results of the study were published online late last month, as part of the March issue of the Journal of the American Geriatrics Society.

Results showed that 60% of long-term care residents with dementia were taking cholinesterase inhibitors along with anticholinergic drugs, which are commonly prescribed for ailments like depression, sleep problems and incontinence. Those medications have been shown to cause cognitive impairment and confusion.

The study also showed that residents who saw multiple physicians over the course of a year had increased drug burdens and risk of drug interactions. On average, long-term care residents saw an average of 10 different physicians, researchers found.

Lead researcher Paula Rochon, M.D., MPH, told the Globe and Mail that her team's findings should serve as a warning for healthcare providers to closely monitor and manage the number of drugs prescribed to long-term care residents.

“The results of the current study suggest that receiving care from multiple physicians may be partly responsible for the high anticholinergic drug burden in this population,” Rochon wrote. “There is a growing need for collaborative, innovative approaches to optimizing drug therapy for older adults with dementia.”

Medication consultations, pharmacist interventions, prescriber audits and electronic decision-making tools can help improve the appropriateness of prescriptions for long-term care residents, Rochon noted.