Drug-related problems in the elderly - Interventions to improve the quality of pharmacotherapy

Abstract: Introduction: Elderly people, in particular those residing in nursing homes, often use many drugs. In general elderly patients are at greater risk of experiencing drug-related problems (DRP), as they have multiple diseases, are using many drugs and have changed physiological status. Objectives: To describe the frequency of potential drug-related problems in the elderly and to evaluate different kinds of interventions that are meant to reduce the number of potential drug-related problems in the elderly. Methods: (Paper I) All information on medication use in nursing home patients with epilepsy or Parkinson's disease was collected. A multi-speciality team evaluated nursing home patients' medication and, when appropriate, suggested changes. (Paper II) Elderly patients that had been discharged from hospital were identified. All information on their medications prior to, during and after hospital care was collected. Medication errors during transfer between care levels were identified. (Paper III) Educational outreach visits were offered General Practitioner (GP) practices. Data on prescribing of benzodiazepines and anti-psychotic drugs to elderly before and after this education was compared with a control group of GP practices. (Paper IV) Implementation of a medication report when elderly patients are discharged from hospital care. Results: Inappropriate medications are common in nursing homes. Medication errors are frequent when elderly patients are transferred between hospital and primary care (Papers II and IV). Advice from a multi-speciality team did not have any positive effects on the quality of life in nursing home patients (Paper I). Educational outreach visits are well appreciated by GPs and can affect their prescribing habits leading to a decrease in prescribing of inappropriate medications to elderly patients (Paper III). Medication Report is effective in reducing the number of medication errors when elderly patients are transferred from hospital to primary care (Paper IV). Conclusions: The research comprising this thesis has demonstrated a need for attention towards drug-related problems in the elderly. Educational outreach visits are effective in affecting GPs prescribing habits. Medication report is a simple but very effective instrument to decrease the number of medication errors when elderly patients are discharged from hospital.