Assessing Polypharmacy in Nursing Home Residents in Spain

Findings of an observational cross-sectional study carried out in a Spanish nursing home revealed a high prevalence of polypharmacy and drug-related interactions among patients, with results underscoring the need for regular evaluation of drug prescribing to minimize associated risks.

Writing in the International Journal of Environmental Research and Public Health,researchers explained how currently, over 19% of the Spanish population is aged 65 or older, accounting for nearly a fifth of the country’s population. This total increased by more than 2 million in just 2 decades while projections estimate this population will grow in coming years.

“Ageing leads to an increased burden on health care systems, as older adults often have multiple diseases and require several medications, which favors polypharmacy,” authors wrote. Comorbidities, age-related physiological changes, and worsening of pre-existing conditions can all lead to poorer outcomes in this patient population, and thus may exacerbate polypharmacy.

In an effort to better elucidate the pattern of polypharmacy in an elderly population living in a nursing home and its relationship with drug-related problems (DRP), researchers assessed data collected between February and July 2021 from 222 residents. The nursing home is located in León, Spain, one of the country’s most aging regions.

All included drugs required a prescription and had been administered for at least 1 month prior to data collection, authors explained, with polypharmacy broken down into 3 categories: non-polypharmacy (0–4 medicines), polypharmacy (5–9 medicines), and excessive polypharmacy (at least 10 medicines).

Potentially inappropriate medication (PIM) was defined according to STOPP/START criteria, while software was used to classify severe and moderate drug-drug interactions (DDIs).

Mean (SD) patient age was 85.5 (7.8) years and the majority of patients (67.1%) were female; all study participants also had at least 2 chronic conditions with hypertension, cognitive impairment and cataracts being the most common.

Analyses revealed:

• Residents were on a median of 7 medicines (range 0 to 17)
• Polypharmacy and inappropriate medications were present in 78.8% and 96.8% of residents, respectively
• DDIs were very common in participants (81.1%), being severe/moderate in 24.7%.
• DRPs numbered 3111, with a median of 10 DRP per resident; no DRP was detected in only 3 residents (1.4%)
• The number of DDIs was significantly associated with polypharmacy and excessive polypharmacy
• The most frequent drugs involved in DDIs were lorazepam (17.4%), trazodone (15.4%), mirtazapine (11.7%), escitalopram (11.4%) and alprazolam (9.7%)
• 684 drugs were involved in potential adverse drug reactions (ARDs)
• Excessive dosing was seen in 2.5% of residents and underdosing in 1.7%, with escitalopram seen as the most overdosed drug

Findings align with results from previous studies, researchers wrote, adding “the main challenge associated with polypharmacy is the appearance of different DRPs, especially DDIs and ADRs.”

Polypharmacy also leads to increased drug costs and health care system utilization, while in recent years, improving drug prescription in elderly populations has garnered significant attention. Current Spanish guidelines recommend nursing home patients with polypharmacy have their medications reviewed every 6 months.

The study’s small sample size marks a limitation; over-the-counter medications were also not included in the analysis. Differences in prescribing between regions is also possible.

Overall, anticholinergic risk and comorbidities were significantly associated with polypharmacy in this study.

“Establishing a detailed understanding of the patterns and characteristics of potential inappropriate polypharmacy in the elderly may provide a basis for minimizing the health and economic consequences caused by inappropriate polypharmacy,” authors concluded.

Reference

Díez R, Cadenas R, Susperregui J, et al. Drug-related problems and polypharmacy in nursing home residents: a cross-sectional study. Int J Environ Res Public Health. Published online April 4, 2022. doi:10.3390/ijerph19074313