Please select the eligibility criteria that correspond to the clinical trial below.
Title: Discontinuing Inappropriate Medication in Nursing Home Residents (the DIM NHR Study): a Cluster Randomized Controlled Trial
Brief Summary: Nursing home residents are among the frailest patient groups with a high number of co-morbidities and a high use of medicines. Inappropriate polypharmacy (i.e. often overprescribing) is one of the major problems in the nursing home population increasing the number of adverse drug reactions, falls, hospital admissions, mortality as well as having an impact on health care utilization. Multidisciplinary medication reviews have a great potential to reduce inappropriate medication use. The purpose of this study is to determine the efficacy of a multidisciplinary medication review model focussing on discontinuing inappropriate medication in a cluster randomized controlled trial in 600 nursing home residents. The primary outcome measure is the difference in proportion of residents who successfully discontinued medication between intervention and control group after four months. Secondary outcome measures will be the drug burden index, adverse drug withdrawal events related to the discontinued medication, death, referral to hospitals and quality of life.


Options:
A: Nursing Home Wards:

Inclusion criteria:

* Long stay ward
* Capability and commitment to perform a multidisciplinary multistep medication review.

Exclusion criteria:

* Short stay, revalidation or observation wards
* Specialized ward where patients with an atypical etiology are cared for.
* Elderly care physicians who have recently received or who are to receive recertification at short notice with regard to systematic medication review methodology.
* Participation in other studies aimed at improving the quality of drug prescription (in the past 12 months).

Nursing Home Residents:

Inclusion criteria:

* A life expectancy of \>4 weeks as judged by the treating elderly care physician.
* IC provided by patients themselves or provided by a legal representative for incapacitated patients.

Exclusion criteria:

* Refusal of treatment with medicines.
* Having received a multidisciplinary systematic medication review in the past 6 months.
* Being terminally ill and having a life expectancy ≤ 4 weeks as judged by the treating elderly care physician.
* Other reasons at the discretion of the elderly care physician / nursing staff
B: Inclusion Criteria:

* Patients 65-74 years of age with multimorbidity (3 or more chronic diseases) and polypharmacy (5 or more drugs taken for at least three months).
* Informed consent.

Exclusion Criteria:

* Institutionalized patient at nursing homes or similar
* Life expectancy \< 12 months
C: Inclusion Criteria:

* Age greater than or equal to 65
* Resident in EHPAD
* presenting a high iatrogenic drug risk (Trivalle score between 6-10).
* Ability to provide free, informed and express consent (patient and / or trusted person)
* Affiliated to a social security scheme

Exclusion Criteria:

* Patient with a life expectancy \<3 months
* Patient under 65 years
* Trivale score \<6
* Vulnerable persons within the meaning of French law (adults under guardianship or trusteeship, persons deprived of their liberty)
* Participation in another research protocol in progress
* Patient who has had a medication review (or medication review) known in the last 6 months.
* Patient with severe dementia (MMSE \<18)
D: Inclusion Criteria:

* people aged 75 years or older

Exclusion Criteria:

* people aged 75 years or older
* refusal of consent to participate
* a life expectancy of less than 6 months

Answer: A