Polypharmacy in nursing home residents with severe cognitive impairment: Results from the SHELTER Study

Abstract

Older people often have multiple chronic diseases, resulting in the concomitant use of multiple drug therapies, defined as polypharmacy, and leading to an elevated rate of iatrogenic illnesses [ 1 x [1] Lee, P.G., Cigolle, C., and Blaum, C. The co-occurrence of chronic diseases and geriatric syndromes: the Health and Retirement Study. J Am Geriatr Soc. 2009; 57: 511–516 Crossref | PubMed | Scopus (127) | Google Scholar See all References , 2 x [2] Onder, G., Petrovic, M., Tangiisuran, B., Meinardi, M.C., Markito-Notenboom, W.P., Somers, A. et al. Development and validation of a score to assess risk of adverse drug reactions among in-hospital patients 65 years or older: the GerontoNet ADR risk score. Arch Intern Med. 2010; 170: 1142–1148 Crossref | PubMed | Scopus (147) | Google Scholar See all References ]. The best practice recommended by clinical guidelines seems to be the major cause of polypharmacy [ 3 x [3] Van den Akker, M., Buntinx, F., Metsemakers, J.F., Roos, S., and Knottnerus, J.A. Multimorbidity in general practice: prevalence, incidence, and determinants of co-occurring chronic and recurrent diseases. J Clin Epidemiol. 1998; 51: 367–375 Abstract | Full Text | Full Text PDF | PubMed | Scopus (553) | Google Scholar See all References ] [3] . Nevertheless, geriatric patients are usually excluded by the major clinical trials so that no clear evidence is available to drive the decision-making process in these complex patients [ 4 x [4] Bernabei, R., Caputi, A., Di Cioccio, L., Fini, M., Gallo, P.F., Marchionni, N. et al. Need for redesigning pharmacologic research in older individuals: a position statement of the Geriatric Working Group of the Agenzia Italiana del Farmaco (AIFA). J Gerontol A Biol Sci Med Sci. 2011; 66: 66–67 Crossref | PubMed | Scopus (11) | Google Scholar See all References , 5 x [5] Cho, S., Lau, S.W., Tandon, V., Kumi, K., Pfuma, E., and Abernethy, D.R. Geriatric drug evaluation: where are we now and where should we be in the future?. Arch Intern Med. 2011; 171: 937–940 Crossref | PubMed | Scopus (31) | Google Scholar See all References , 6 x [6] Fusco, D., Lattanzio, F., Tosato, M., Corsonello, A., Cherubini, A., Volpato, S. et al. Development of CRIteria to assess appropriate Medication use among Elderly complex patients (CRIME) project: rationale and methodology. Drugs Aging. 2009; 26: 3–13 Crossref | PubMed | Scopus (30) | Google Scholar See all References , 7 x [7] Zulman, D.M., Sussman, J.B., Chen, X., Cigolle, C.T., Blaum, C.S., and Hayward, R.A. Examining the evidence: a systematic review of the inclusion and analysis of older adults in randomized controlled trials. J Gen Intern Med. 2011; 26: 783–790 Crossref | PubMed | Scopus (169) | Google Scholar See all References ]. According to guidelines, physicians should treat, on average, every disease with three drugs, and in adults age 80 and older with an average of 3.3 diseases, this results in an average of 10 drugs per person [ 3 x [3] Van den Akker, M., Buntinx, F., Metsemakers, J.F., Roos, S., and Knottnerus, J.A. Multimorbidity in general practice: prevalence, incidence, and determinants of co-occurring chronic and recurrent diseases. J Clin Epidemiol. 1998; 51: 367–375 Abstract | Full Text | Full Text PDF | PubMed | Scopus (553) | Google Scholar See all References ] [3] .