Inappropriate Drugs Can Harm Nursing Home Patients

Wrong ones used intermittently linked to higher hospitalization, death rates

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HealthDay Reporter

MONDAY, Jan. 17, 2005 (HealthDayNews) -- Nursing home residents treated intermittently with drugs for common ailments such as depression, arthritis or sinus problems over a three-month period were almost 90 percent more likely to die at the end of that period than were patients who didn't take such drugs, new research shows.

Further, residents who took these potentially inappropriate medications over a two-month period had an 80 percent greater chance of being hospitalized in the third month than did patients who were not given such drugs.

The report appears in the current issue of the Archives of Internal Medicine.

"We're not saying that taking these medicines causes the hospitalizations and deaths. But our work shows that there's a relationship between the two and that doctors should pay attention to the drugs that they prescribe, and monitor their patients carefully," said study author Denys Lau, a professor at Northwestern University's Feinberg School of Medicine.

Adding to significance of the findings, Lau said, is that his previous work has found that at least half of all Americans aged 65 and older who stay in a nursing home for three months or longer are given at least one potentially inappropriate medicine.

"At least 50 percent of nursing home residents take these medications, so the scope is pretty dramatic and troubling," he said.

Lau said there could be several reasons for the significant association between drug intake and increased hospitalizations and deaths.

Many of the most commonly prescribed drugs for nursing home residents, such as Darvon (for pain), Elavil (for depression), Digoxin (for heart problems) and Endal (an antihistamine), have side effects that can include dizziness, blurry vision, constipation and sleepiness. These side effects can affect an elderly patient's balance and alertness, so falls and other health problems are more likely, Lau said.

So, while there might not be a direct link to a specific drug and an increased risk of health trouble, the side effects can increase the chances of complications that eventually lead to hospitalization or early death, the study found.

"The effect of these side effects could be magnified in the elderly in kind of a trickle-down effect," Lau said.

Also a factor, Lau said, is that there have been very few clinical trials on how drugs affect the elderly. As people age, drugs affect them differently: the rate of absorption of drugs by the liver changes; the way the drugs metabolize in the body changes; and drugs are often eliminated more slowly, making toxicity an issue.

But while all this is known, said Lau, there is very little evidence-based data on exactly how differently drugs affect this age group.

In prescribing drugs to the elderly, most practitioners rely primarily on the Beers criteria, a list compiled and revised in the last decade by doctors. The list names drugs that doctors should try to avoid when treating the elderly because of possibly harmful effects. If doctors do use these drugs, they are required to document why they are using them.

However, many doctors still prescribe medicines on this list, which include Darvon, Elavil and Digoxin, often because of habit on the part of both patients and doctors -- many patients have taken these drugs on and off for many years and are reluctant to change, Lau said.

But there are many newer drugs that would help these patients with fewer side effects, he said.

Interestingly, Lau noted, those nursing home residents who stayed on a drug for an extended period of time -- three months or longer -- were at no higher risk for hospitalization and death.

"The risk seemed to rise when the patient regimens fluctuate back and forth between drugs," he said.

"This is a great study, and I am not surprised at all by the findings," said C.W. Fetrow, an associate clinical professor at the University of Pittsburgh School of Pharmacy. His company, Apothecare Collaborative Services Inc., monitors the medicines residents take in nursing homes.

"As pharmacists, we're already clued into this, and now there's proof that these drugs aren't working and that there are better choices for the elderly," Fetrow said.

Fetrow added that while pharmacists monitor the drugs patients in nursing homes take, they are not the prescribing doctor and are often not included in decisions about what drugs the residents should take.

"Look to pharmacists for this information," he said. "We are trained to tease out the subtle differences in these drugs."

Lau's study was based on data from the 1996 Medical Expenditure Panel Survey Nursing Home Component, which included 3,372 residents, 65 years or older, who had nursing home stays of three consecutive months or longer.

The participants in the study were controlled for age, sex, and mental and physical health.

More information

The Medical College of Georgia explains the Beers criteria.

SOURCES: Denys Lau, Ph.D., assistant professor, Buehler Center on Aging, Feinberg School of Medicine, Northwestern University, Chicago; C.W. Fetrow, Pharm.D., associate clinical professor, University of Pittsburgh School of Pharmacy, Jan. 10, 2005, Archives of Internal Medicine

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