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Attitudes to Drug Use in Residential Aged Care Facilities: A Cross-Sectional Survey of Nurses and Care Staff

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Abstract

Background

Residential aged care facility (RACF) staff are well placed to identify opportunities for more appropriate prescribing. However, little is known about their views of polypharmacy, deprescribing and specific medications.

Objective

The objective of this study was to establish the beliefs and attitudes of RACF staff towards polypharmacy and medication use in residents.

Methods

A cross-sectional survey was conducted on RACF staff in metropolitan New South Wales, Australia using a self-administered questionnaire. The questionnaire was drafted based on the available literature and research team expertise and then piloted by a mixed group of 13 RACF staff. The final version of the questionnaire consisted of 28 questions. A total of 38 RACFs were contacted about the study. The questionnaire was distributed to eligible RACF staff between October 2017 and October 2019. The RACF staff were eligible if they provided direct patient care to residents or worked as a facility manager. Participants were excluded if they had insufficient English language skills. The results were presented in two groups, the nursing and care staff, using descriptive statistics.

Results

A total of 176 individuals from nine RACFs completed the questionnaire of whom 160 were eligible for study inclusion. Most considered polypharmacy to be five or more different tablets and capsules per day (95% nursing and 82% care staff respectively). A wide range of beliefs about medication use and deprescribing that centred on what constitutes appropriate polypharmacy was identified. Most thought that preventive medications were essential for residents. Most nurses agreed that sleeping tablets and pharmacological management of verbal aggression and wandering behaviours should be used less frequently whilst most care staff agreed that medications should be used more frequently to manage physical aggression.

Conclusions

To successfully and sustainably optimise medication use in RACF residents, it is important to consider the variation in views of nurses and care staff.

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Acknowledgements

The authors acknowledge Ms. Leanne Kearney for her contribution to the design and critical revision of the manuscript for important intellectual content and Mr. Terry Jin for his assistance with acquisition of the data (Centre for Education and Research on Ageing, Concord Repatriation General Hospital and Concord Clinical School).

Author information

Authors and Affiliations

  1. Centre for Education and Research on Ageing, Concord Repatriation General Hospital and Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia

    Sarita Y. Lo & Vasi Naganathan

  2. Laboratory of Ageing and Pharmacology, Royal North Shore Hospital and Northern Clinical School, Faculty of Medicine and Health, Kolling Institute of Medical Research, University of Sydney, Sydney, NSW, Australia

    Sarita Y. Lo & Sarah N. Hilmer

  3. Quality Use of Medicines and Pharmacy Research Centre, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia

    Emily Reeve

  4. Geriatric Medicine Research, Faculty of Medicine, and College of Pharmacy, Dalhousie University and Nova Scotia Health Authority, Halifax, NS, Canada

    Emily Reeve

  5. Western Australian Centre for Health and Ageing, University of Western Australia, Perth, WA, Australia

    Amy T. Page & Christopher Etherton-Beer

  6. Pharmacy Department, Alfred Health, Melbourne, VIC, Australia

    Amy T. Page

  7. Centre for Medicine Use and Safety, Monash University, Melbourne, VIC, Australia

    Amy T. Page

  8. School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds, UK

    Syed Tabish R. Zaidi

  9. Sydney School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia

    Andrew McLachlan

  10. Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia

    Lisa Pont

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  1. Sarita Y. Lo
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Corresponding author

Correspondence to Sarita Y. Lo.

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Funding

This research did not receive any funding from agencies in the public, commercial or not-for-profit sectors. Emily Reeve is supported by a National Health and Medical Research Council‐Australian Research Council Dementia Research Development Fellowship. Amy T. Page is supported by an National Health and Medical Research Council Early Career Fellowship (1156892).

Conflict of interest

Sarita Y. Lo, Emily Reeve, Amy T. Page, Syed Tabish R. Zaidi, Sarah N. Hilmer, Christopher Etherton-Beer, Andrew McLachlan, Lisa Pont and Vasi Naganathan have no conflicts of interest that are directly relevant to the content of this article.

Ethics approval

The questionnaire and methodology for this study were approved by the Human Research Ethics Committee of The University of Sydney (Ethics approval number: 2016/072).

Consent to participate

The return/online submission of the completed questionnaire was regarded as implicit consent for participation in the study.

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Not applicable.

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The authors confirm that all relevant data are included in the article and/or its supplementary information files.

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Not applicable.

Authors’ contributions

All authors meet the criteria for authorship stated in the Uniform Requirements for Manuscripts Submitted to Biomedical Journals. VN conceptualised and designed the work, supervised the acquisition, analysis, and interpretation of the data, and assisted with the drafting and critical revision of the manuscript. SYL made substantial contributions to the design, the acquisition, analysis, and interpretation of the data, and drafting of the manuscript. ER, ATP and STRZ made substantial contributions to the design, analysis, and interpretation of data and critical revision of the manuscript for important intellectual content. CEB, SNH, AMcL and LP made substantial contributions to the analysis and interpretation of data and revised it critically for important intellectual content. All authors revised the manuscript and have approved the submitted version.

Appendix A: NADIR questionnaire

Appendix A: NADIR questionnaire

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Lo, S.Y., Reeve, E., Page, A.T. et al. Attitudes to Drug Use in Residential Aged Care Facilities: A Cross-Sectional Survey of Nurses and Care Staff. Drugs Aging 38, 697–711 (2021). https://doi.org/10.1007/s40266-021-00874-2

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  • DOI: https://doi.org/10.1007/s40266-021-00874-2

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