Trends in potentially inappropriate medication prescribing to nursing home patients: comparison of three cross-sectional studies

Abstract

Purpose: The aim of this study was to examine trends in potentially inappropriate medication (PIM) prescribing in Norwegian nursing homes.

Methods: Patients aged ≥70 years were included from three cross-sectional studies conducted in 1997, 2005 and 2011. PIMs were analyzed according to the Norwegian General Practice-Nursing Home criteria (NORGEP-NH), use of single substances to avoid, combinations to avoid, and deprescribing items. Associations between sample and use of PIMs were examined by logistic regression, adjusted for age, gender, and ward. We established Pearsons r for correlations between numbers of drugs and PIMs.

Results: Altogether, 4373 patients (mean age 85.7 years, 73.5% women) were included. The mean overall number of drugs per patient increased from 4.7 in 1997 to 6.9 in 2011 (p < 0.001). Use of any single substances to avoid increased from 36.8% in 1997 to 39.5% in 2011 (p = 0.002), use of any combinations to avoid from 16.3% to 27.0% (p < 0.001), and use of any deprescribing items from 46.0% to 55.3% (p < 0.001). Use of codeine-analgesics, nonsteroidal anti-inflammatory drugs, tricyclic antidepressants, long-acting benzodiazepines, and first generation antihistamines decreased significantly, while use of short-acting benzodiazepines, z-hypnotics, statins, and anti-dementia drugs increased significantly. A moderate strong correlation was detected between number of drugs and the three above-mentioned PIM categories, r = 0.34, r = 0.43, r = 0.37, respectively (all p < 0.001).

Conclusions: Although several PIMs were less commonly prescribed in recent years, increased overall use of PIMs may suggests worsening of prescribing quality for nursing home patients in Norway. Copyright © 2016 John Wiley & Sons, Ltd.

Keywords: Norway; drug therapy; frail elderly; nursing homes; pharmacoepidemiology; potentially inappropriate medication list.