title: The war against polypharmacy: a new cost-effective geriatric-palliative approach for improving drug therapy in disabled elderly people.
abstract: BACKGROUND
  The extent of medical and financial problems of polypharmacy in the elderly is disturbing, particularly in nursing homes and nursing departments.
  
  
  OBJECTIVE
  To improve drug therapy and minimize drug intake in nursing departments.
  
  
  METHODS
  We introduced a geriatric-palliative approach and methodology to combat the problem of polypharmacy. The study group comprised 119 disabled patients in six geriatric nursing departments; the control group included 71 patients of comparable age, gender and co-morbidities in the same wards. After 12 months, we assessed whether any change in medications affected the death rate, referrals to acute care facility, and costs.
  
  
  RESULTS
  A total of 332 different drugs were discontinued in 119 patients (average of 2.8 drugs per patient) and was not associated with significant adverse effects. The overall rate of drug discontinuation failure was 18% of all patients and 10% of all drugs. The 1 year mortality rate was 45% in the control group but only 21% in the study group (P < 0.001, chi-square test). The patients' annual referral rate to acute care facilities was 30% in the control group but only 11.8% in the study group (P < 0.002). The intervention was associated with a substantial decrease in the cost of drugs.
  
  
  CONCLUSIONS
  Application of the geriatric-palliative methodology in the disabled elderly enables simultaneous discontinuation of several medications and yields a number of benefits: reduction in mortality rates and referrals to acute care facilities, lower costs, and improved quality of living.
authors.affiliation: Department of Evaluation & Rehabilitation, Shoham Geriatric Medical Center, Pardes Hana, Israel. dorong@shoham.health.gov.il
authors.forename: Doron
authors.initials: D
authors.lastname: Garfinkel
authors.forename: Sarah
authors.initials: S
authors.lastname: Zur-Gil
authors.forename: Joshua
authors.initials: J
authors.lastname: Ben-Israel
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D016527:Drug Costs; D016903:Drug Monitoring; D004363:Drug Utilization / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D016330:Frail Elderly; D006299:Health Services for the Aged / Q000592:standards*; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D009026:Mortality; D009735:Nursing Homes / Q000191:economics / Q000592:standards*; D010166:Palliative Care; D019338:Polypharmacy; D011788:Quality of Life