Suboptimal Pharmacotherapy in a Tribal Nursing Home
published online 06 June 2006.
Objective
Suboptimal medication use among nursing home (NH) residents is common. NH residents tend to be older, suffer from multiple conditions, and take numerous medications, increasing their risk of serious complications. This article examines pharmacotherapy in a rural, tribally owned NH.
Design
Medical records were reviewed and case studies were conducted by a team composed of a medical anthropologist, psychiatrist, and geriatrician.
Setting
A rural, American Indian–owned NH in the US northern plains.
Participants
40 American Indian and 5 EuroAmerican NH residents.
Measurements
Minimum Data Set assessments, admission records, care plans, social histories, prescription lists, and behavioral consultation reports.
Results
Potential underuse affected almost 75% of residents; undertreatment of depressive and psychotic/agitated symptoms was especially common. Potential inappropriate use, especially of analgesics, psychotropics, and antihistamines, affected 30% of residents. A smaller, but still substantial, number of residents (21%) experienced potential overuse, much of which involved anticonvulsants, antibiotics, cardiovascular, and psychotropic agents. The prescription of 10 or more medications was significantly associated with potential drug interactions, as well as underuse, inappropriate medication use, and overuse.
Conclusions
Psychotropic medications were the most potentially problematic medication category, and were strongly implicated in potential underuse, inappropriate use, and overuse. Fewer medications; the discontinuation of drugs known to be potentially problematic for NH residents; modification of psychotropic medication regimens; use of cognitive-enhancing medications where appropriate; implementation of an electronic medical record system; and greater use of nonpharmacological behavioral interventions may have substantially improved residents’ treatment regimens.
aAmerican Indian and Alaska Native Programs, Department of Psychiatry, University of Colorado at Denver and Health Sciences Center (UCDHSC), Aurora, CO
bDenver VA Medical Center and Department of Medicine, UCDHSC, Denver, CO.
Address correspondence to Lori L. Jervis, PhD, American Indian and Alaska Native Programs, Department of Psychiatry, University of Colorado at Denver and Health Sciences Center (UCDHSC), PO Box 6508, MS F800, Aurora, CO 80045.
This study was funded by the Administration on Aging (Spero M. Manson, PI; A0A 90AM 2381).
The funders played no role in the study’s design or execution. None of the authors have any financial conflicts of interest in the study. The description of the authors’ contributions to this study is described in the methods section; all were involved in data analysis and manuscript writing. Dr Jervis developed the project and directed data collection. Dr Manson’s grant from the Administration on Aging funded the project.
ABSTRACT