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Reducing polypharmacy in long-term care units
Dissertation   Open access

Reducing polypharmacy in long-term care units

Maria Magsalin
Doctor of Nursing Practice (D.N.P.), Drexel University
2017
DOI:
https://doi.org/10.17918/etd-7385
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Abstract

Polypharmacy Drugs--Prescribing Older people--Long-term care Nursing
Background: Polypharmacy is prevalent in nursing home residents and has been associated with negative outcomes such as falls, adverse events, cognitive and functional decline, non-adherence, hospitalization and even death. Despite interventions focused on reducing use of inappropriate drugs in elderly people there is still a need to create a process to safely and effectively reduce polypharmacy in this population. A systemic tapering or discontinuation of unnecessary medication called deprescribing has been documented to decrease polypharmacy and exhibited encouraging results in improving patient outcome in nursing home residents. Purpose: To implement a deprescribing process with the goal of tapering or discontinuing unnecessary medications and evaluate the effect of deprescribing medication to the functional status of elderly living in long-term care facility. Method: A one group pre-test and post-test quasi-experimental design was used to determine differences in functional status and number of medications at baseline and 6 weeks after the implementation of the deprescribing process among older adult residents of a long term rehabilitation facility. Functional status was measured using the modified Katz Activities of Daily Living (ADL: Katz). Patients' responses to the discontinuation of medication were documented for 4 weeks. Data were analyzed using descriptive statistics and paired - test. Results: 25 older adults participated in the study. The majority are women ((76%) with a mean age of 84.8 years and average number of prescribed medicine was 9.52 (SD = 4.3). The results showed a significant decrease in the number of medications from baseline and 6 weeks (t = 2.17, p = .007) There was no significant difference (t = 2.06, p = .32) in functional status at baseline and 6 weeks. Conclusion: Deprescribing process in older adults is feasible without adverse effects. Despite the small sample size and short study duration it is encouraging to observe that a patient-centered deprescribing process can safely reduce the number medicines consumed by elderly residents in nursing home without any adverse effect.

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