Nursing homes tend to administer high-risk medications to returning residents, study shows

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Nursing homes may be ratcheting up high-risk medication use for certain residents who return to the facility after a stay in the hospital, according to recently published findings.

Among nursing home residents who were eligible both for Medicare and Medicaid, about 20% were on a high-risk medication the day before they are hospitalized, the investigators determined. They defined high-risk drugs as those meeting Beers Criteria for being potentially inappropriate for older adults, such as anticholinergics (which could cause confusion, urinary problems and vision problems).

Of the residents on a high-risk med prior to hospitalization, about 45% were on a high-risk drug three days after returning from the hospital, the study authors found. This percentage increased to nearly 60% by 30 days after readmission to the nursing home.

“Although some high-risk medication use may have been initiated during the hospital stay, nursing homes seem to have played a role in driving the use of such medications by hospitalized residents who return to the facility,” the authors wrote. They also noted that hospital-skilled nursing facility coordination may be poor, but this does not appear to be driving the use of high-risk medications in the nursing home setting.

This high-risk prescribing is an “important clinical challenge” for nursing homes, the investigators concluded. They suggested increased regulatory oversight as a potential remedy. Efforts to scale back antipsychotic use could be a model for addressing this issue, they proposed.

The findings are based on Medicare and pharmacy claims data from 2008, for more than 52,500 dual-eligible nursing home residents. The authors acknowledged that medication management has evolved since the study period.

The investigators were affiliated with a variety of institutions, including Vanderbilt University School of Medicine, the Geisel School of Medicine at Dartmouth College and the Hebrew Senior Life Institute for Aging Research in Boston. Findings appear in Medical Care and have been published online ahead of print.