polypharmacy

A new report offers guidance for safely “deprescribing” the number of drugs being administered to nursing home residents of which an estimated half receive nine or more medications. 

The United Hospital Fund collaborated with six New York City-area nonprofit facilities to pilot reducing the number of medications being given to seniors, the cumulative effects of which could be detrimental to their overall health. The report, “Reducing the Risk: Year 1 Report of the Polypharmacy in Nursing Homes Learning Collaborative,” was released Tuesday. 

“This report demonstrates that overall public awareness about the risks of polypharmacy in older adults, attention to medication reconciliation across all care settings, and family engagement are all key to successful and safe deprescribing efforts,” said Oxiris Barbot, MD, president and CEO of United Hospital Fund. “We hope nursing homes across the city, state and country will learn from the report’s tools, resources, and approaches.”

The program found that the number of residents taking 10 or more medications decreased by 16% after implementing describing interventions such as changing medication review processes or increasing staff, resident and family education.

 In one instance, a facility found that its psychiatry partner “was a key driver” of a high number of prescriptions, which decreased after getting the prescriber’s buy-in to the program to reduce medications. Another facility developed weekly nutrition meetings between the medical director and dieticians to determine the necessity of multivitamin regimens. 

The participating facilities were: Archcare at Mary Manning Walsh Home; Cobble Hill Health Center; Eger Health Care and Rehabilitation Center; Gurwin Jewish Nursing and Rehabilitation Center; The Hebrew Home at Riverdale; and the Jamaica Hospital Nursing Home. They range in size from 148 long-term care beds to 480 beds; two are part of larger healthcare systems while the rest are independent facilities. 

Each nursing home identified two to three medications from a list developed by the UHF team that were frequently prescribed in their building and that might be harmful for seniors. They were then asked to determine the polypharmacy drivers in their organizations and to develop intervention plans.

The average number of medications prescribed per resident decreased from 10.7 to 8.7 over the course of the program’s first year, the report noted. 

“An estimated 50 percent of nursing home residents receive nine or more medications, and their rate of adverse drug reactions is twice as high as that of residents taking fewer than nine,” the report stated. “While the use of multiple medications is often appropriate in managing patients with complex chronic diseases, some medications may be unnecessary, duplicative, have limited benefit, cause a range of harmful side effects, or be inconsistent with a resident’s care goals or current practice standards.”

In one instance, successfully “deprescribing” dementia medication to an underweight patient resulted in the man’s appetite improving and gaining weight. One of the participating facilities reported saving $40,000 in pharmacy bills within seven weeks of beginning its intervention programs.