Polypharmacy in nursing home in Europe: results from the SHELTER study.
BACKGROUND
This study assesses prevalence and patients characteristics related to polypharmacy in a sample of nursing home residents.


METHODS
We conducted a cross-sectional analysis on 4,023 nursing home residents participating to the Services and Health for Elderly in Long TERm care (SHELTER) project, a study collecting information on residents admitted to 57 nursing home in 8 countries. Data were collected using the interRAI instrument for long-term care facilities. Polypharmacy status was categorized in 3 groups: non-polypharmacy (0-4 drugs), polypharmacy (5-9 drugs) and excessive polypharmacy (≥ 10 drugs).


RESULTS
Polypharmacy was observed in 2,000 (49.7%) residents and excessive polypharmacy in 979 (24.3%) residents. As compared with non-polypharmacy, excessive polypharmacy was directly associated not only with presence of chronic diseases but also with depression (odds ratio [OR] 1.81; 95% confidence interval [CI] 1.38-2.37), pain (OR 2.31; 95% CI 1.80-2.97), dyspnoea (OR 2.29; 95% CI 1.61-3.27), and gastrointestinal symptoms (OR 1.73; 95% CI 1.35-2.21). An inverse association with excessive polypharmacy was shown for age (OR for 10 years increment 0.85; 95% CI 0.74-0.96), activities of daily living disability (OR for assistance required vs independent 0.90; 95% CI 0.64-1.26; OR for dependent vs independent 0.59; 95% CI 0.40-0.86), and cognitive impairment (OR for mild or moderate vs intact 0.64; 95% CI 0.47-0.88; OR for severe vs intact 0.39; 95% CI 0.26-0.57).


CONCLUSIONS
Polypharmacy and excessive polypharmacy are common among nursing home residents in Europe. Determinants of polypharmacy status include not only comorbidity but also specific symptoms, age, functional, and cognitive status.
Centro Medicina dell'Invecchiamento, Dipartimento di Scienze Gerontologiche, Geriatriche e Fisiatriche, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Roma, Italy. graziano_onder@rm.unicatt.it
Graziano
G
Onder
Rosa
R
Liperoti
Daniela
D
Fialova
Eva
E
Topinkova
Matteo
M
Tosato
Paola
P
Danese
Pietro Folino
PF
Gallo
Iain
I
Carpenter
Harriet
H
Finne-Soveri
Jacob
J
Gindin
Roberto
R
Bernabei
Francesco
F
Landi
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D003072:Cognition Disorders / Q000188:drug therapy; D003430:Cross-Sectional Studies; D003863:Depression / Q000188:drug therapy / Q000453:epidemiology; D004417:Dyspnea / Q000188:drug therapy / Q000453:epidemiology; D005060:Europe / Q000453:epidemiology; D005260:Female; D005767:Gastrointestinal Diseases / Q000188:drug therapy; D019538:Health Care Surveys / Q000706:statistics & numerical data*; D006299:Health Services for the Aged / Q000706:statistics & numerical data; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D008134:Long-Term Care / Q000706:statistics & numerical data; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data*; D019338:Polypharmacy; D015995:Prevalence; D012720:Severity of Illness Index