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Improper Prescribing Found at Assisted Living Facilities

Kate Traynor

One in six seniors living in a residential care or assisted living facility, where monthly medication reviews by pharmacists are not the norm, may be receiving drugs that are inappropriate for the elderly, according to a recently published study.

North Carolina researchers examined the medication administration records for 2,014 seniors at 193 assisted living and residential care facilities in Florida, New Jersey, North Carolina, and Maryland. Using a modified version of the 1997 Beers criteria for determining inappropriate medication use in nursing-home residents, the research team found that 369 of 11,649 prescriptions were written for potentially inappropriate medications. In all, 322 of the seniors involved in the study received at least one drug that is not considered safe for use by elderly people.

The results of the study appeared in the June issue of the Journal of the American Geriatrics Society.

Sixty-two of the residents had recently received at least four doses of oxybutynin, the most commonly administered drug considered inappropriate for seniors. At least 25 of the residents were prescribed propoxyphene, amitriptyline, diphenhydramine, ticlopidine, or doxepin, medications that are not deemed safe for seniors.

Patients who regularly received at least four medications were more likely than other patients to have been prescribed an inappropriate drug. The research team suggested that efforts to reduce inappropriate prescribing should focus on patients who receive the greatest number of medications.

Other factors that seemed to contribute to inappropriate medication use in this study included a moderate turnover of licensed practical nurses, lack of weekly visits by a physician, and small facility size, which was defined as fewer than 16 beds.

According to the report, the amount of inappropriate prescribing in this study was somewhat less than in previous investigations involving homebound seniors and elderly people living in board-and-care homes. The research team speculated that the amount of inappropriate prescribing may actually be decreasing because of changes in prescribing practices and other factors. For example, the researchers noted that oxybutynin was reformulated after this study ended and is now available in an extended-release form that may be safe for seniors.

The research team suggested that "increased oversight by consultant pharmacists, though not assessed in this study, may be able to further reduce" inappropriate medication use among residents of assisted living and residential care facilities. Consultant pharmacists, the report noted, typically conduct a monthly review of medication use for residents of nursing homes, which have lower rates of inappropriate prescribing than was found in the current study.