title: Prevalence and associations of potentially inappropriate prescriptions in Austrian nursing home residents: secondary analysis of a cross-sectional study.
abstract: BACKGROUND
  Potentially inappropriate prescriptions (PIP) are an important cause of adverse medication-related events and increases morbidity, hospitalization, and health care costs, especially in nursing home residents. However, little is known about the associations between PIP and residents' characteristics.
  
  
  OBJECTIVE
  The aim of our study was to analyse the prevalence and associations of PIP with residents' and facilities' characteristics.
  
  
  METHODS
  We performed a secondary analysis of a cross-sectional study with 48 out of 50 eligible nursing homes and 1,844 out of 2,005 eligible residents in a defined rural-urban area in Austria. The Austrian list of potentially inappropriate medications was applied for the evaluation of inappropriate prescribing. Cluster-adjusted multiple regression analysis was used to investigate institutional and residents' characteristics associated with PIP.
  
  
  RESULTS
  Mean cluster-adjusted prevalence of residents with at least one PIP was 70.3 % (95 % CI 67.2-73.4). The number of residents with at least one psychotropic PIP was 1.014 (55 %). The most often prescribed PIP were Prothipendyl (25.9 % residents), Lorazepam (14.5 %) and Diclofenac (6.1 %). Multiple regression analysis showed an inverse association of PIP with cognitive impairment and significant positive associations with permanent restlessness and permanent negative attitude. The associations of PIP with age and male gender were inconsistent. No significant associations were found for PIP and the ratio of staff nurses to residents.
  
  
  CONCLUSIONS
  Our study results confirm that PIP is highly prevalent in the nursing home population. These results urgently call for effective interventions. Initiatives and successful interventions performed in other countries could serve as examples for safer prescribing in residents in Austria.
authors.affiliation: Institute of General Medicine, Family Medicine and Preventive Medicine, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria. evamann@vol.at
authors.forename: Eva
authors.initials: E
authors.lastname: Mann
authors.forename: Burkhard
authors.initials: B
authors.lastname: Haastert
authors.forename: Birgit
authors.initials: B
authors.lastname: Böhmdorfer
authors.forename: Thomas
authors.initials: T
authors.lastname: Frühwald
authors.forename: Bernhard
authors.initials: B
authors.lastname: Iglseder
authors.forename: Regina
authors.initials: R
authors.lastname: Roller-Wirnsberger
authors.forename: Gabriele
authors.initials: G
authors.lastname: Meyer
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D001317:Austria / Q000453:epidemiology; D003072:Cognition Disorders / Q000188:drug therapy / Q000453:epidemiology*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D004008:Diclofenac / Q000627:therapeutic use; D005260:Female; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D008140:Lorazepam / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009732:Nursing Care / Q000706:statistics & numerical data*; D009735:Nursing Homes / Q000706:statistics & numerical data*; D055656:Prescriptions / Q000706:statistics & numerical data*; D015995:Prevalence; D011595:Psychomotor Agitation / Q000188:drug therapy / Q000453:epidemiology*; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D018570:Risk Assessment
chemical_list: D011619:Psychotropic Drugs; D004008:Diclofenac; D008140:Lorazepam
references.citation: BMJ Qual Saf. 2011 Mar;20(3):275-81
references.pmid: 21209143
references.citation: Pharmacoepidemiol Drug Saf. 2011 Jan;20(1):12-9
references.pmid: 20848559
references.citation: J Am Geriatr Soc. 1986 Oct;34(10):722-7
references.pmid: 3760436
references.citation: Eur J Clin Pharmacol. 2007 Aug;63(8):725-31
references.pmid: 17554532
references.citation: BMJ. 2006 Apr 1;332(7544):756-61
references.pmid: 16543297
references.citation: Int Rev Psychiatry. 2008 Aug;20(4):396-404
references.pmid: 18925489
references.citation: Drugs Aging. 2012 May 1;29(5):359-76
references.pmid: 22550966
references.citation: Wien Klin Wochenschr. 2012 Mar;124(5-6):160-9
references.pmid: 22134410
references.citation: Ann Pharmacother. 2009 Jul;43(7):1233-8
references.pmid: 19584395
references.citation: Cochrane Database Syst Rev. 2012 Dec 12;12:CD008634
references.pmid: 23235663
references.citation: Trials. 2012 Jun 18;13:85
references.pmid: 22709731
references.citation: BMC Geriatr. 2006 Jan 11;6:1
references.pmid: 16403236
references.citation: CMAJ. 1997 Feb 1;156(3):385-91
references.pmid: 9033421
references.citation: Drugs Aging. 2008;25(1):49-59
references.pmid: 18184029
references.citation: Eur J Clin Pharmacol. 1999 Feb;54(12):959-63
references.pmid: 10192758
references.citation: Arch Intern Med. 2008 Sep 22;168(17):1890-6
references.pmid: 18809816
references.citation: Age Ageing. 2007 Sep;36(5):549-54
references.pmid: 17881422
references.citation: Int Psychogeriatr. 2011 Dec;23(10):1632-9
references.pmid: 21813036
references.citation: Drugs Aging. 2012 Aug 1;29(8):639-58
references.pmid: 22812538
references.citation: J Gerontol A Biol Sci Med Sci. 2012 Jun;67(6):698-704
references.pmid: 22219520
references.citation: Pharmacoepidemiol Drug Saf. 2012 Apr;21(4):428-34
references.pmid: 22344680
references.citation: J Am Med Dir Assoc. 2012 Nov;13(9):818.e11-5
references.pmid: 22959733
references.citation: Arch Intern Med. 1991 Sep;151(9):1825-32
references.pmid: 1888249
references.citation: JAMA. 2005 Oct 19;294(15):1934-43
references.pmid: 16234500
references.citation: Arch Intern Med. 2005 Jan 10;165(1):68-74
references.pmid: 15642877
references.citation: Ann Pharmacother. 2012 Mar;46(3):339-46
references.pmid: 22318931
references.citation: Br J Psychiatry. 2009 Mar;194(3):212-9
references.pmid: 19252147
references.citation: Biometrics. 2000 Jun;56(2):645-6
references.pmid: 10877330
references.citation: Dtsch Arztebl Int. 2010 Aug;107(31-32):543-51
references.pmid: 20827352
references.citation: BMJ. 2008 Aug 28;337:a1227
references.pmid: 18755769
references.citation: Res Nurs Health. 2008 Feb;31(1):42-51
references.pmid: 18163447
references.citation: Trials. 2016 Jan 29;17:57
references.pmid: 26822311
references.citation: J Am Geriatr Soc. 2012 Apr;60(4):616-31
references.pmid: 22376048
references.citation: Drugs Aging. 2010 May;27(5):407-15
references.pmid: 20450238
references.citation: Drugs Aging. 2008;25(8):683-92
references.pmid: 18665660
references.citation: Ren Fail. 2012;34(10):1344-7
references.pmid: 22963504
references.citation: Drugs Aging. 2012 Mar 1;29(3):167-179
references.pmid: 22350526
references.citation: Br J Clin Pharmacol. 2004 Jan;57(1):6-14
references.pmid: 14678335
references.citation: J Clin Pharm Ther. 2011 Feb;36(1):33-44
references.pmid: 21198718
references.citation: Int J Clin Pharmacol Ther. 2008 Feb;46(2):72-83
references.pmid: 18218287
references.citation: BMC Geriatr. 2009 Jul 23;9:30
references.pmid: 19627577
references.citation: Ann Intern Med. 2007 Jun 5;146(11):775-86
references.pmid: 17548409
references.citation: BMC Geriatr. 2009 May 21;9:18
references.pmid: 19460135
references.citation: Scand J Prim Health Care. 2007 Mar;25(1):9-14
references.pmid: 17354153
references.citation: Am J Nephrol. 2012;36(3):245-51
references.pmid: 22964976
references.citation: Front Neurol. 2012 May 07;3:73
references.pmid: 22586419
references.citation: J Am Med Dir Assoc. 2012 Feb;13(2):187.e7-187.e13
references.pmid: 21549645
references.citation: Med Care. 2007 May;45(5):472-6
references.pmid: 17446834
references.citation: Int Psychogeriatr. 2010 May;22(3):346-72
references.pmid: 20096151
references.citation: Drugs Aging. 2010 Sep 1;27(9):747-58
references.pmid: 20809664