Meaningful Deprescribing in the Nursing Home
Authors: Holly M. Holmes, Greg A. Sachs
Journal: Annals of Internal Medicine (2017)

Editorials7 November 2017Meaningful Deprescribing in the Nursing HomeHolly M. Holmes, MD, MS and Greg A. Sachs, MDHolly M. Holmes, MD, MSFrom University of Texas Health Science Center McGovern Medical School, Houston, Texas, and Indiana University School of Medicine and Regenstrief Institute, Indianapolis, Indiana.Search for more papers by this author and Greg A. Sachs, MDFrom University of Texas Health Science Center McGovern Medical School, Houston, Texas, and Indiana University School of Medicine and Regenstrief Institute, Indianapolis, Indiana.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M17-2268 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Despite efforts to reduce potentially inappropriate medication (PIM) use, prescribing quality has worsened in the nursing home setting. Twenty-seven percent to 71% of nursing home residents use at least 1 PIM, and PIM use is associated with increased risk for falls, delirium, and cognitive impairment (1). Medication use is particularly risky in nursing homes given that they have a frail population with a high prevalence of dementia and multimorbidity.In this issue, Wouters and colleagues report the results of a deprescribing study targeting PIM use in nursing homes (2). In this cluster randomized trial, 426 nursing home residents recruited from ...References1. Halvorsen KH, Selbaek G, Ruths S. Trends in potentially inappropriate medication prescribing to nursing home patients: comparison of three cross-sectional studies. Pharmacoepidemiol Drug Saf. 2017;26:192-200. [PMID: 27935150] doi:10.1002/pds.4142 CrossrefMedlineGoogle Scholar2. Wouters H, Scheper J, Koning H, Brouwer C, Twisk JW, van der Meer H, et al. Discontinuing inappropriate medication use in nursing home residents. A cluster randomized controlled trial. Ann Intern Med. 2017;167:609-17. doi:10.7326/M16-2729 LinkGoogle Scholar3. Garfinkel D, Mangin D. Feasibility study of a systematic approach for discontinuation of multiple medications in older adults: addressing polypharmacy. Arch Intern Med. 2010;170:1648-54. [PMID: 20937924] doi:10.1001/archinternmed.2010.355 CrossrefMedlineGoogle Scholar4. Maclagan LC, Maxwell CJ, Gandhi S, Guan J, Bell CM, Hogan DB, et al. Frailty and potentially inappropriate medication use at nursing home transition. J Am Geriatr Soc. 2017. [PMID: 28752589] doi:10.1111/jgs.15016 CrossrefMedlineGoogle Scholar5. Tjia J, Rothman MR, Kiely DK, Shaffer ML, Holmes HM, Sachs GA, et al. Daily medication use in nursing home residents with advanced dementia. J Am Geriatr Soc. 2010;58:880-8. [PMID: 20406320] doi:10.1111/j.1532-5415.2010.02819.x CrossrefMedlineGoogle Scholar6. Lavan AH, Gallagher P, Parsons C, O'Mahony D. STOPPFrail (Screening Tool of Older Persons Prescriptions in Frail adults with limited life expectancy): consensus validation. Age Ageing. 2017. [PMID: 28119312] doi:10.1093/ageing/afx005 CrossrefMedlineGoogle Scholar7. Khodyakov D, Ochoa A, Olivieri-Mui BL, Bouwmeester C, Zarowitz BJ, Patel M, et al. Screening Tool of Older Person's Prescriptions/Screening Tools to Alert doctors to Right Treatment medication criteria modified for U.S. nursing home setting. J Am Geriatr Soc. 2017;65:586-591. [PMID: 28008599] doi:10.1111/jgs.14689 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University of Texas Health Science Center McGovern Medical School, Houston, Texas, and Indiana University School of Medicine and Regenstrief Institute, Indianapolis, Indiana.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-2268.Corresponding Author: Holly M. Holmes, MD, MS, Division of Geriatric and Palliative Medicine, University of Texas Health Science Center McGovern Medical School, 6431 Fannin, MSB 5.111, Houston, TX 77030; e-mail, Holly.m.[email protected]tmc.edu.Current Author Addresses: Dr. Holmes: Division of Geriatric and Palliative Medicine, University of Texas Health Science Center McGovern Medical School, 6431 Fannin, MSB 5.111, Houston, TX 77030.Dr. Sachs: Department of Medicine (F2-624), Indiana University, 5/3 Faculty Office Building, 720 Eskenazi Avenue, Indianapolis, IN 46202.This article was published at Annals.org on 10 October 2017. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoDiscontinuing Inappropriate Medication Use in Nursing Home Residents Hans Wouters , Jessica Scheper , Hedi Koning , Chris Brouwer , Jos W. Twisk , Helene van der Meer , Froukje Boersma , Sytse U. Zuidema , and Katja Taxis Metrics Cited byApplication of the GheOP 3 S-tool in nursing home residents: acceptance and implementation of pharmacist recommendationsA systems approach to identifying the challenges of implementing deprescribing in older adults across different health-care settings and countries: a narrative reviewDeprescribing in Nursing Home Residents on Polypharmacy: Incidence and Associated FactorsAssociations of potentially inappropriate medication use with four year survival of an inception cohort of nursing home residents 7 November 2017Volume 167, Issue 9Page: 671-672KeywordsBeerDementiaDisclosureForecastingFrailtyGeriatricsLife expectancyNursing homesPharmacistsQuality of life ePublished: 10 October 2017 Issue Published: 7 November 2017 Copyright & PermissionsCopyright © 2017 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...