[Use of drugs in residents of homes for the elderly and nursing homes in comparison with patients in ambulatory care or without need of care]

Abstract

Background and objective: Only a few studies have been done in Germany on the use of drugs in homes for the elderly and nursing homes. This is the first retrospective and longitudinal pharmaco-epidemiological study comparing the pattern of drug prescriptions for patients in nursing or for-the-elderly homes with that for health-insured ambulant patients or those not requiring care, all of them of the same age-group.

Patients and methods: The samples were taken from a cohort of 3592 members of a company health insurance in Berlin, aged 60 years or over (912 men, 2680 women) who had been insured throughout 1999. The insurance company's database provided anonymous information on the insured and their doctors, details of drug prescriptions and hospital treatment. The patients were divided into three groups, group A: all those requiring care who lived in homes for the elderly or nursing homes (n=996); group B: all ambulant patients receiving care (n=1603), and group C: patients not requiring care, matched to the other groups for age and sex (n=993). All drugs were classified according to the anatomical-therapeutic-chemical WHO codes and listed by defined daily dosage (DDD).

Results: Those in group A received on average 3.6 DDD daily, those of group B 4.6 DDD, and those of group C 3.0 DDD. The relevant cost was 714 Euro (group A), 1126 Euro (group B) and 539 Euro (group C) per person in 1999. Indications of inadequate treatment concerned the use of psychopharmaceuticals (neuroleptics, antidepressives, hypnotics), analgesics, digitalis glycosides, antidiabetic drugs, diuretics, laxatives, and drugs of unproven efficacy. 15% of home residents received prescription from doctors on emergency call. These drugs were often continued beyond the immediate treatment.

Conclusion: These data provide evidence of the lacking quality in the drug treatment of the elderly.