Seven out of ten older people in nursing homes in Ireland are being given inappropriate medication, according to a report unveiled today.
Benzodiazepines, nonsteroidal anti-inflammatories and medicines used to treat urinary incontinence and indigestion were found to be the drugs most commonly inappropriately prescribed.
The report was funded by the Centre for Ageing Research and Development in Ireland (CARDI) and carried out by a cross-Border research team led by Dr Stephen Byrne, senior lecturer in clinical pharmacy at University College Cork.
A total of 315 residents over 65 were randomly selected from 14 nursing homes in Co Cork and were age- and gender-matched with 315 residents of nursing homes in Northern Ireland. Their medical notes were reviewed in detail between December 2009 and September 2010.
It was discovered 73 per cent of nursing home residents in the Republic were receiving at least one potentially inappropriate medicine while 67 per cent of those in nursing homes in the North were affected by the issue. Nearly one-fifth of those reviewed were receiving three or more inappropriate medicines. The cost of this was estimated at €356 per person.
The prescribing of benzodiazepines, sedatives such as valium and diazepam, to patients with a history of falls or fainting was highlighted as a particular problem. These sedatives accounted for more than half of the inappropriate medication prescribed.
Giving benzodiazepines to people already predisposed to falls can cause further falls and fractures given their muscle relaxing properties and can cause psychological and physical dependency, the report found.
Another problem identified was that of patients being left on high doses of certain drugs indefinitely.
“For example, we found that patients are being left on high doses of proton pump inhibitors (PPIs) to treat acid indigestion when the dose should have been stepped down to a maintenance dose after eight weeks,” said Dr Byrne.
Dr Byrne also highlighted the problem of the “prescribing cascade” where one drug is given to manage the side-effects of another.
“For example, a person with arthritis is put on nonsteroidal anti-inflammatory drugs to treat the pain. And as a consequence of this, they develop hypertension so instead of the anti-inflammatory being reviewed and stopped and perhaps the pain being managed by regular paracetamol, medicine is added in for the treatment of high blood pressure. It’s a phenomenon known as the prescribing cascade,” he said.
He stressed that the problem of inappropriate prescribing was a global one.
“It isn’t always related to over-prescribing either. Sometimes it relates to under-prescribing for example where patients with osteoporosis are not receiving calcium and vitamin D supplements when they should be”
The report recommends greater collaboration between pharmacists, GPs, consultants and nurses to ensure patients only receive the medicines they need. Patients should have their medication reviewed at least once a year, it said.
The report will be presented to the Minister for Health James Reilly and the Health Information and Quality Authority (HIQA) tomorrow.
Age Action spokesman, Eamon Timmins, said the report was “disturbing” and called for immediate action by the Minister for Health.
“The implications of these findings are very serious for the potential threat posed for older people’s health, as well as the huge sums being paid by the State for medications which are not only not needed, but which may in fact be damaging people’s health.”
A spokeswoman for the Older and Bolder alliance, a group of organisations representing or working with older people, said they were very concerned by the report.