Study,Sep/20:Variation between nursing homes in drug use & drug-related problems

The full title of this Norwegian study is "Variation between nursing homes in drug use and in drug-related problems".

 

https://pubmed.ncbi.nlm.nih.gov/32907532/

 

Abstract

 

Background: Residents at nursing homes (NHs) are at particular risk for drug related harm. Regular medication reviews using explicit criteria for pharmacological inappropriateness and classification of drug related problems (DRPs) have recently been introduced as measures to improve the quality of medication use and for making the treatment more uniform across different institutions. Knowledge about variation in DRPs between NHs is scarce. To explore if increased attention towards more appropriate drug treatment in NHs have led to more uniform treatment, we have analyzed variations between different nursing homes' drug use and DRPs.

 

Methods: Cross-sectional medication review study including 2465 long-term care residents at 41 NHs in Oslo, Norway. Regular drug use was retrieved from the patients' medical records. DRPs were identified by using STOPP/START and NORGEP criteria and a drug-drug interactions database. NHs were grouped in quartiles based on average levels of drug use. The upper and lower quartiles were compared using independent samples t-test and associations between drug use and DRPs were tested by logistic regression.

 

Results: Patients' mean age was 85.9 years, 74.2% were women. Mean numbers of regular drugs per patient was 6.8 and varied between NHs from 4.8 to 9.3. The proportion of patients within each NH using psychotropic and analgesic drugs varied largely: antipsychotics from three to 50%, benzodiazepines from 24 to 99%, antidepressants from nine to 75%, anti-dementia drugs from no use to 42%, opioids from no use to 65% and paracetamol from 16 to 74%. Mean DRPs per patient was 2.0 and varied between NHs from 0.5 to 3.4. The quartiles of NHs with highest and lowest mean drugs per patient (7.7 vs. 5.7, p < 0.001) had comparable mean number of DRPs per patient (2.2 vs. 1.8, p = 0.2). Using more drugs and the use of opioids, antipsychotics, benzodiazepines and antidepressants were associated with more DRPs.

 

Conclusions: The use of psychotropic and analgesic drugs was high and varied substantially between different NHs. Even if the use of more drugs, opioids and psychotropic drugs was associated with DRPs, no difference was found in DRPs between the NHs with highest vs. lowest drug use.

 

Full Study:

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7488067/pdf/12877_2020_Article_1745.pdf

Lapis, this is a huge nightmare of mine, ending up in a nursing home. I know only too well how liberal the people who work in those places are with their meds. I shudder to think. I probably would do like a woman in the nursing home I used to work at in high school did - just stopped eating and drinking. I'd be dead, anyway, with those pills, I'm afraid.

Yes, I feel the same, Terry. I shudder to think about it.

 

As you know, I've posted many studies on this topic, and clearly, medication is over-used. Despite the many calls for change that I've seen in these papers, I still see numerous studies that result in the same findings. In this particular paper, it says that benzodiazepines were given to 24-99% of the population they studied. If a nursing home is giving benzos to 99% of its population, and no alarm bells are ringing, then something is very wrong. It's quite a shocking number.

I hate these so-called medications right now, mainly because their widest use seems to be to make mostly healthy people sick.

 

Hopefully they're giving out cannabis in the nursing homes by that time but I can imagine quite a few scenarios as an 80-something stuck in a nursing home where I'd take whatever I could get. Or potentially I'd have such little agency that it wouldn't matter.

 

In 50 years time, things will probably be radically different. We may have given humans the same right to end their suffering via euthanasia that we currently allow dogs, for example.

Here in Canada, we do have Medical Assistance in Dying (MAID), but it's hard to get -- as it should be. There's quite a bit of legislation involved.

 

On the medication issue, there are already things in place that should discourage doctors from doling out psych meds like candy to older people, but again, it doesn't seem that the recommendations are always followed.

Here in Canada, we do have Medical Assistance in Dying (MAID), but it's hard to get -- as it should be. There's quite a bit of legislation involved.

 

On the medication issue, there are already things in place that should discourage doctors from doling out psych meds like candy to older people, but again, it doesn't seem that the recommendations are always followed.

 

I've seen death occur from the very young to the very old from many different causations. The commonality I've noticed is that toward the end of life, all of those I've seen would give anything to ease the symptoms related to their death. Based upon my observations; group-think, religion, politics, regulations, etc. should be kept out of how someone chooses to die. Those decisions are best left to the dying individuals.

Just to clarify, the study above isn't necessarily talking about end-of-life situations, i.e. the last days. It's looking at "regular drug use", "drug related harm" and "drug related problems (DRPs)" in these nursing homes in Norway, according to the abstract.

Yes, I feel the same, Terry. I shudder to think about it.

 

As you know, I've posted many studies on this topic, and clearly, medication is over-used. Despite the many calls for change that I've seen in these papers, I still see numerous studies that result in the same findings. In this particular paper, it says that benzodiazepines were given to 24-99% of the population they studied. If a nursing home is giving benzos to 99% of its population, and no alarm bells are ringing, then something is very wrong. It's quite a shocking number.

 

The problem is that there are lots of people who are very sensitive to pills (I'm one of them and I'm sure you are, too), yet they treat everyone the same. There needs to be a massive overhaul of the medical system in general, but they keep doing the same thing - a good interpretation of insanity.

Just to clarify, the study above isn't necessarily talking about end-of-life situations, i.e. the last days. It's looking at "regular drug use", "drug related harm" and "drug related problems (DRPs)" in these nursing homes in Norway, according to the abstract.

 

"the last days" ... "The average age of participants when they moved to a nursing home was about 83. The average length of stay before death was 13.7 months, while the median was five months. Fifty-three percent of nursing home residents in the study died within six months." https://www.ucsf.edu/news/2010/08/98172/social-support-key-nursing-home-length-stay-death

 

Here is the math: 83 years x 365 days per year = 30,295 days in typical persons' lives before typical admissions to nursing homes. The median length of stay before death is 5 months x 30 days per month = 150 days. 150 days / 30,445 (30,295 + 150) days = approximately 0.5% of one's life. Typically, admission to a nursing home may be considered one's "last days" i.e. 0.5% of one's life. In other words upon admission and subsequent death in a nursing home, a typical person has lived 99.5% of their life.

 

I stand by my previously stated opinion: "Based upon my observations; group-think, religion, politics, regulations, etc. should be kept out of how someone chooses to die. Those decisions are best left to the dying individuals."

Yes, I feel the same, Terry. I shudder to think about it.

 

As you know, I've posted many studies on this topic, and clearly, medication is over-used. Despite the many calls for change that I've seen in these papers, I still see numerous studies that result in the same findings. In this particular paper, it says that benzodiazepines were given to 24-99% of the population they studied. If a nursing home is giving benzos to 99% of its population, and no alarm bells are ringing, then something is very wrong. It's quite a shocking number.

 

The problem is that there are lots of people who are very sensitive to pills (I'm one of them and I'm sure you are, too), yet they treat everyone the same. There needs to be a massive overhaul of the medical system in general, but they keep doing the same thing - a good interpretation of insanity.

 

Hi Terry,

Yes, there are obviously differences in how individuals metabolize various medications. Genes play a large role. Perhaps, in future, there will be more use of pharmacogenetics in determining who gets what and how much.

 

The first line of the abstract says, "Residents at nursing homes (NHs) are at particular risk for drug related harm." While I haven't read the full study, there is likely a reference in there to the changes in liver and kidney function that occur as people age. Such changes can play a role in how elderly people metabolize medications, and can result in slower clearing of medications from the body and cumulative effects.

 

I know that in my case, the use of clonazepam on the schedule that I took it -- two times per day -- likely caused cumulative effects, because it's a longer-acting medication. And I'm not yet in the older age category. I read a study years ago that looked at cumulative effects of benzodiazepines, and it really made me think about my own situation. I'm quite sure that was a factor for me in terms of why things got worse and worse over time.

 

 

Yes, it's very true that older people metabolize pills very slowly, yet they're the age bracket that gets the most pills ironically.

 

And I found that nursing home patients generally spent a lot of time in bed not exercising, which can cause insomnia and constipation, so they were given pills for that. Add up all the pills they were taking every day, and the liver and kidneys trying so hard to clear all the pills from the body at some point buckle.

 

When I think about all the pills I've taken, I'm shocked. I was just following the doctors' prescriptions. But I finally came to my senses and realized that ALL pills had a paradoxical effect, and my beta blockers block epinephrine, later converting to adrenaline when they wear off. This ups my bp to a great extent. I got an okay from the doctor to taper off, but unfortunately I got a UTI, and again my bp has soared because I'm allergic to antibiotics. And they can cause more damage to the kidneys. It's a wonder the kidneys can even function with all the pills that are thrown at it. I have to put off tapering until my bp goes down.

 

By the way, Lapis, I'm mostly eating a vegan diet now, trying to heal myself. I didn't see many vegetables in the nursing home. Usually food was canned. I'm hoping things are much better now, but I'm not holding my breath.

Yes, it's very true that older people metabolize pills very slowly, yet they're the age bracket that gets the most pills ironically.

 

And I found that nursing home patients generally spent a lot of time in bed not exercising, which can cause insomnia and constipation, so they were given pills for that. Add up all the pills they were taking every day, and the liver and kidneys trying so hard to clear all the pills from the body at some point buckle.

 

When I think about all the pills I've taken, I'm shocked. I was just following the doctors' prescriptions. But I finally came to my senses and realized that ALL pills had a paradoxical effect, and my beta blockers block epinephrine, later converting to adrenaline when they wear off. This ups my bp to a great extent. I got an okay from the doctor to taper off, but unfortunately I got a UTI, and again my bp has soared because I'm allergic to antibiotics. And they can cause more damage to the kidneys. It's a wonder the kidneys can even function with all the pills that are thrown at it. I have to put off tapering until my bp goes down.

 

By the way, Lapis, I'm mostly eating a vegan diet now, trying to heal myself. I didn't see many vegetables in the nursing home. Usually food was canned. I'm hoping things are much better now, but I'm not holding my breath.

 

Hi Terry we have a loved one in a very good facility, and I think it’s a good idea for loved ones to keep weekly or bi-weekly tabs on the care of the elder (including hard copies of meds,etc) so that the facility knows they are being watched.  This has helped the situation in our case.

Oh, that's great, cs123!! It shows love for the patient and active participation in their care. That's what every patient needs. Making certain that "the powers that be" in nursing homes know that what they are doing is being watched is so valuable. I noticed that if the patients weren't being taken care of, it was easier for the staff to slough off and not take care of them either. People developed bed sores and other painful maladies which could have easily been prevented.

 

I must admit that it was sad to see so many people not being taken care of by families in the nursing home. You could really tell the people that were loved and cared for, and it was so appreciated. They lived longer, too!

 

Good work!!! :thumbsup: