Inappropriate prescribing for older people admitted to an intermediate-care nursing home unit and hospital wards

Abstract

Objective: to identify inappropriate prescribing among older patients on admission to and discharge from an intermediatecare nursing home unit and hospital wards, and to compare changes during stay within and between these groups. Design: observational study. Setting and subjects: altogether 400 community-dwelling people aged 70 years, on consecutive emergency admittance to hospital wards of internal medicine and orthopaedic surgery, were randomized to an intermediatecare nursing home unit or hospital wards; 290 (157 at the intermediate-care nursing home unit and 133 in hospital wards) were eligible for this sub-study. Main outcome measures: prevalence on admission and discharge of potentially inappropriate medications (Norwegian general practice [NORGEP] criteria) and drug – drug interactions; changes during stay. Results: the mean (SD) age was 84.7 (6.2) years; 71% were women. From admission to discharge, the mean numbers of drugs prescribed per person increased from 6.0 (3.3) to 9.3 (3.8), p 0.01. The prevalence of potentially inappropriate medications increased from 24% to 35%, p 0.01; concomitant use of 3 psychotropic/opioid drugs and drug combinations including non-steroid anti-inflammatory drugs (NSAIDs) increased significantly. Serious drug – drug interactions were scarce both on admission and discharge (0.7%). Conclusions: inappropriate prescribing was prevalent among older people acutely admitted to hospital, and the prevalence was not reduced during stay at an intermediate-care nursing home unit specially designed for these patients.