Prevalence of appropriate and problematic antiepileptic combination therapy in older people in the nursing home.
OBJECTIVE
To determine the prevalence of mono- and poly-antiepileptic drug (AED) therapy in a cohort of nursing home (NH) residents and to describe specific AED combinations used, as well as demographic, clinical, and functional factors associated with poly-AED therapy and the most common AED combination.


METHODS
Retrospective, point prevalence study.


METHODS
All NHs owned/managed by Beverly Enterprises.


METHODS
All residents aged 65 and older residing in one of the study NHs on July 1, 1999, and receiving an AED (N=3,881).


METHODS
Data were gathered using two secondary source data sets: physicians' orders (AED use) and the Minimum Data Set (health status indicators).


RESULTS
Of residents taking AEDs, 370 (9.5%) were taking two or more; 268 of those (72%) were taking problematic AED combinations (those with the potential of undesirable pharmacokinetic or pharmacodynamic interactions). Phenytoin (PHT) with phenobarbital (PB) was the most common combination (27.0%). Logistic regression indicated that poly-AED subjects were more likely to have a diagnosis of epilepsy/seizure (epi/sz) and less likely to have a diagnosis of cerebrovascular accident (CVA). Residents taking the PHT/PB combination were more likely to have an epi/sz diagnosis and longer NH stay. The association between CVA and PHT/PB polytherapy differed by presence or absence of aphasia.


CONCLUSIONS
The overall prevalence of poly-AED therapy is less than 10% in NH residents, but 72% of those residents were receiving problematic polytherapy combinations, thereby exposing them to potential risk of adverse reactions and toxicity.
Harms
Susan L
SL
Division of Health Services Research and Policy, School of Public Health, University of Minnesota, Minneapolis, Minnesota 55455, USA. harms010@tc.umn.edu
Eberly
Lynn E
LE
Garrard
Judith M
JM
Hardie
Nancy A
NA
Bland
Pat C
PC
Leppik
Ilo E
IE
D017677:Age Distribution; D000368:Aged / Q000706:statistics & numerical data*; D000544:Alzheimer Disease / Q000453:epidemiology; D000927:Anticonvulsants / Q000008:administration & dosage*; D003430:Cross-Sectional Studies; D004359:Drug Therapy, Combination; D004363:Drug Utilization; D004827:Epilepsy / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D005598:Fractures, Spontaneous / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008910:Minnesota / Q000453:epidemiology; D015999:Multivariate Analysis; D009735:Nursing Homes / Q000706:statistics & numerical data*; D017891:Pharmacoepidemiology; D019338:Polypharmacy; D015995:Prevalence; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy / Q000453:epidemiology
D000927:Anticonvulsants