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Reduction of Inappropriate Medications among Older Nursing-Home Residents

A Nurse-Led, Pre/Post-Design, Intervention Study

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Abstract

Background: Medication-related problems are common in the growing population of older adults and inappropriate prescribing is a preventable risk factor. Explicit criteria such as the Beers criteria provide a valid instrument for describing the rate of inappropriate medication (IM) prescriptions among older adults.

Objective: To reduce IM prescriptions based on explicit Beers criteria using a nurse-led intervention in a nursing-home (NH) setting.

Study Design: The pre/post-design included IM assessment at study start (pre-intervention), a 4-month intervention period, IM assessment after the intervention period (post-intervention) and a further IM assessment at 1-year follow-up.

Setting: 204-bed inpatient NH in Bern, Switzerland.

Participants: NH residents aged ≥60 years.

Intervention: The intervention included four key intervention elements: (i) adaptation of Beers criteria to the Swiss setting; (ii) IM identification; (iii) IM discontinuation; and (iv) staff training.

Main Outcome Measure: IM prescription at study start, after the 4-month intervention period and at 1-year follow-up.

Results: The mean±SD resident age was 80.3±8.8 years. Residents were prescribed a mean±SD 7.8±4.0 medications. The prescription rate of IMs decreased from 14.5% pre-intervention to 2.8% post-intervention (relative risk [RR] = 0.2; 95% CI 0.06, 0.5). The risk of IM prescription increased nonstatistically significantly in the 1-year follow-up period compared with post-intervention (RR = 1.6; 95% CI 0.5, 6.1).

Conclusions: This intervention to reduce IM prescriptions based on explicit Beers criteria was feasible, easy to implement in an NH setting, and resulted in a substantial decrease in IMs. These results underscore the importance of involving nursing staff in the medication prescription process in a long-term care setting.

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Acknowledgements

This research was supported by institutional funds from the University of Bern. Andreas Born and Eva Blozik were supported by a Forschungskolleg Geriatrie Grant from the Robert Bosch Foundation, Stuttgart, Germany. The funding bodies had no influence on the design and conduct of the study; the collection, management, analysis and interpretation of the data; or the preparation, review or approval of the manuscript. The authors have no conflicts of interest that are directly relevant to the content of this study. The authors thank the practitioners and nurses involved in this study, who generously gave their time to ensure the success of this project.

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Authors and Affiliations

  1. Division of Geriatrics, Department of General Internal Medicine, Inselspital and University of Bern, Bern, Switzerland

    Eva Blozik, Andreas M. Born &  Andreas E. Stuck

  2. Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland

    Eva Blozik, Gerhard Gillmann & Kerri M. Clough-Gorr

  3. Institute of Social Medicine, University of Lübeck, Lübeck, Germany

    Eva Blozik

  4. Wohn- und Pflegeheim Utzigen, Utzigen, Switzerland

    Ulrich Benninger

  5. National Institute for Cancer Epidemiology and Registration, Institute of Social and Preventive Medicine, University of Zurich, Zurich, Switzerland

    Kerri M. Clough-Gorr

  6. Section of Geriatrics, Boston University Medical Center, Boston, Massachusetts, USA

    Kerri M. Clough-Gorr

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  1. Eva Blozik
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  2. Andreas M. Born
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  3. Andreas E. Stuck
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  4. Ulrich Benninger
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  6. Kerri M. Clough-Gorr
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Correspondence to Andreas E. Stuck.

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Blozik, E., Born, A.M., Stuck, A.E. et al. Reduction of Inappropriate Medications among Older Nursing-Home Residents. Drugs Aging 27, 1009–1017 (2010). https://doi.org/10.2165/11584770-000000000-00000

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  • DOI: https://doi.org/10.2165/11584770-000000000-00000

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