Potentially inappropriate medication and its associated factors in older people living in nursing homes: a cross-sectional study.

BACKGROUND

Institutionalized residents tend to use more drugs and in larger doses. Potentially inappropriate medications (PIM) use is highly prevalent among them. In addition, they are more likely to be prescribed multiple medications (polypharmacy). Moreover, many drugs considered PIM have increased anticholinergic burden (ACB), responsible for adverse drug events (ADE).

OBJECTIVE

Identifying PIM, polypharmacy and ACB among older people's prescriptions as well as their associated factors.

METHODS

Cross-sectional observational multicentre study. Drug information was collected from the nursing homes, medical registers. PIM exposure was assessed using Beers Criteria 2023. ACB was calculated using the Anticholinergic Risk Scale. Other sociodemographic, as well as health-related data were also collected.

RESULTS

130 residents (83.8% women) mean age 85.1 (±7.4). Over 80% (111) of residents have prescriptions including at least one PIM. Polypharmacy (≥5 drugs) occurred in 69.1% (94), while extensive polypharmacy (≥10 drugs) occurred in 18.4% (25). The most prevalent PIMs were benzodiazepines (57.3%; 73), antipsychotics (48.5%; 66) and proton pump inhibitors (39.7%; 54). Regarding ACB, 63.1% (82) of the residents have prescriptions including at least one anticholinergic drug. In the multivariate analysis, ACB ( = 0.018; OR 3.52) and polypharmacy (p=0.015; OR 3.58) were associated with PIM.

CONCLUSIONS

The prevalence of PIM, polypharmacy and ACB was very high (84%, 69%, and 63% respectively) in this sample of nursing home residents. ACB and polypharmacy were significantly associated with PIM. Anticholinergic drugs should be carefully assessed and gradually withdrawn when not needed. Balancing treatment with other biopsychosocial interventions may contribute to reducing polypharmacy.