Inappropriate drug prescription in elderly nursing home residents

Older people consume a large proportion of health care, including drugs, and evidence shows that drug prescribing to this group is often inappropriate. Negative consequences of potential inappropriate drug prescription (PIDP) include adverse drug events, higher health care service utilization and higher costs for the patient and society. Although nursing home residents are the most vulnerable persons exposed to PIDP, few observational studies investigated the prevalence, the factors associated with and the consequences of PIDP. Epidemiological studies assessing the PIDP mainly based on the Beers criteria showed that about half of the U. S. and Canadian nursing home residents have at least one PIDP in this setting. The most frequent inappropriate prescriptions concern the neuroleptic and long-term benzodiazepines. Nursing home residents aged 80 or more years, those with a low number of drugs, cognitive or communication problems, are less exposed to PIDP as compared with those younger than 80 years, living in facilities with high number of beds and lower registered nurse-to-resident ratio. In European countries, the prevalence of PIDP among elderly nursing home residents was comparable or higher to that observed in U. S. and Canadian nursing homes. To date, no published study addressed the issue of PIDP in a representative sample of Italian nursing home residents. In a preliminary study performed in 496 nursing home residents randomly selected from 40 nursing homes in Umbria, the prevalence of residents taking at least one and two inappropriate medications was 28% and 7%, respectively. The prevalence of PIDP considering diagnosis (18%) as well as those regardless of diagnosis (17%), as determined by Beers criteria were equally distributed in older Italian nursing home residents and no difference was found between sexes. Overall, this review reveals that the prevalence of PIDP is high in both North American and European nursing homes and highlights the urgent need for intervention trials testing strategies to reduce the health and social burden of PIDP.