title: Polypharmacy and potentially inappropriate medications: a cross-sectional analysis among 451 nursing homes in France.
abstract: OBJECTIVE
  The quality of drug therapy is an important issue for nursing homes. This study aimed to assess the prevalence of polypharmacy and potentially inappropriate medications (PIMs) in a large sample of nursing home residents by using the data recorded during the preparation of pill dispensers.
  
  
  METHODS
  This is a cross-sectional study that included 451 nursing homes across France. Information about the medications received by the 30,702 residents (73.8% women) living in these nursing homes was extracted from the system that assists in the preparation of pill dispensers in pharmacies. The anonymized database included age, sex, and medications prescribed to residents, as well as nursing home characteristics (capacity, legal status). Factors associated with excessive polypharmacy (≥10 different drugs) and PIMs according to the Laroche list were studied using multilevel regression models.
  
  
  RESULTS
  The average number of drugs prescribed was 6.9 ± 3.3, and excessive polypharmacy concerned 21.1% of the residents (n = 6468). According to the Laroche list, 47.4% of residents (n = 14,547) received at least one PIM. Benzodiazepines (excessive doses, long-acting benzodiazepines, and combination of benzodiazepines) and anticholinergic medications (hydroxyzine, cyamemazine, alimemazine) accounted for a large part of PIMs. Individual characteristics (age, gender) influenced the risk of receiving PIMs whereas nursing home characteristics (capacity, legal status) influenced the risk of excessive polypharmacy.
  
  
  CONCLUSIONS
  This study shows that polypharmacy and PIMs remain highly prevalent among nursing home residents. Main PIMs concerned psychotropic and anticholinergic medications.
authors.affiliation: INSERM, U1168, VIMA: Aging and Chronic Diseases, Epidemiological and Public Health Approaches, F-94807, Villejuif, France. marie.herr@uvsq.fr.|Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, 2, avenue de la source de la Bièvre, F-78180, Montigny le Bretonneux, France. marie.herr@uvsq.fr.|Département Hospitalier d'Epidémiologie et de Santé Publique, Hôpital Sainte Périne, APHP, Paris, France. marie.herr@uvsq.fr.
authors.forename: Marie
authors.initials: M
authors.lastname: Herr
authors.affiliation: INSERM, U1168, VIMA: Aging and Chronic Diseases, Epidemiological and Public Health Approaches, F-94807, Villejuif, France.|Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, 2, avenue de la source de la Bièvre, F-78180, Montigny le Bretonneux, France.
authors.forename: Helene
authors.initials: H
authors.lastname: Grondin
authors.affiliation: Pôle Information Médicale Evaluation Performance, Centre Hospitalier de Troyes, Troyes, France.|Institut du Bien Vieillir, Paris, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Sanchez
authors.affiliation: Korian, Paris, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Armaingaud
authors.affiliation: Medissimo, Poissy, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Blochet
authors.affiliation: AVL, Paris, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Vial
authors.affiliation: Institut du Bien Vieillir, Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Denormandie
authors.affiliation: INSERM, U1168, VIMA: Aging and Chronic Diseases, Epidemiological and Public Health Approaches, F-94807, Villejuif, France.|Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, 2, avenue de la source de la Bièvre, F-78180, Montigny le Bretonneux, France.|Département Hospitalier d'Epidémiologie et de Santé Publique, Hôpital Sainte Périne, APHP, Paris, France.
authors.forename: Joël
authors.initials: J
authors.lastname: Ankri
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D009735:Nursing Homes / Q000458:organization & administration*; D019338:Polypharmacy
keywords: Aged; Frail elderly; Inappropriate prescribing; Information system; Nursing homes; Polypharmacy