Advertisement

Drugs & Aging

, Volume 3, Issue 3, pp 232–237 | Cite as

Institutionalisation and Drug Use in Older Adults in the US

  • Peter P. Lamy
Review Article Drug Therapy

Summary

Since the introduction of Medicaid and Medicare in the US in 1965, the rate of use of nursing homes by elderly persons has more than doubled. Nursing home care accounts for about 8% of the healthcare budget. The rate of nursing home use by elderly people and the subsequent costs are expected to increase during the 1990s.

The elderly nursing home population have a disproportionately high rate of drug consumption; it has been estimated that up to one-third of elderly nursing home residents receive 8 to 12 drugs per day. Multiple drug use is a risk factor for morbidity in elderly patients. Recent regulations have tried to rationalise the use of particular classes of drugs in nursing homes, with some success. However, multiple drug use is not necessarily unjustified, given the complex comorbidity seen in some patients. Since the value of many drugs has not been proven in the elderly population, further studies are required to prove the value of drugs used in this patient population in improving function and quality of life. Regular review of total regimens should be undertaken often.

Keywords

Nursing Home Nursing Home Resident Health Care Financing Isosorbide Dinitrate American Geriatrics Society 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Beers M, Avorn, J, Soumerai SB, Everitt DE, Sherman DS, et al. Psychoactive medication use in intermediate-care facility residents. Journal of the American Medical Association 260: 3016–3020, 1988PubMedCrossRefGoogle Scholar
  2. Blazer DG, Federspiel CF, Ray WA, Schaffner W. The risk of anticholinergic toxicity in the elderly: a study of prescribing practices in two populations. Journal of Gerontology 38: 31–35, 1983PubMedGoogle Scholar
  3. Braun BI. The effect of nursing home quality on patient outcome. Journal of the American Geriatrics Society 39: 329–338, 1991PubMedGoogle Scholar
  4. Breckenridge A. Treating mild hypertension. British Medical Journal 291: 89–90, 1985PubMedCrossRefGoogle Scholar
  5. Brody JA, Foley DJ. Epidemiology considerations. In Schneider et al. (Eds) The teaching nursing home. A new approach to geriatric research, education, and clinical care, pp. 9–25, Raven Press, New York, 1990Google Scholar
  6. Caligiuri MP, Lohr JB, Jeste DV. Instrumental evidence that age increases motor instability in neuroleptic-treated patients. Journal of Gerontology 46: 197–200, 1991Google Scholar
  7. Cohen MA, Tell EJ, Wallack SS. The life time risks and costs of nursing home use among the elderly. Medical Care 24: 116l–l176, 1986Google Scholar
  8. Dahloef B, Lindholm LH, Hansson L, Schersten B, Ekbom T, et al. Morbidity and mortality in the Swedish Trial in Old Patients with Hypertension [(STOP) Hypertension]. Lancet 338: 1281–1285, 1991CrossRefGoogle Scholar
  9. Garrard J, Makris L, Dunham T, Heston LL, Cooper S, et al. Evaluation of neuroleptic drug use by nursing home elderly under proposed Medicare and Medicaid regulations. Journal of the American Medical Association 265: 463–467, 1991PubMedCrossRefGoogle Scholar
  10. Hartzema AG. Improving the quality of pharmaceutical care in Board and Care facilities. Clinical Outcomes 2: 10–11, 1991Google Scholar
  11. Health Care Financing Administration. Medicare and Medicaid: requirements for long term care facilities. Final rule with requests for comments. Federal Register 65: 5316–5336, 1989Google Scholar
  12. Hing E, Sekscenski E, Strahan G. The National Nursing Home Survey: 1985. Summary for the United States. Vital & Health Statistics, Series 13, No. 97, DHHS Pub. No. (PHS) 89-1785. National Center for Health Statistics, Hyattsville, Maryland, 1990Google Scholar
  13. Hypertension Detection and Follow-up Program Cooperative Group. Five-year findings of the Hypertension Detection and Follow-up Program: II. Mortality by race, sex and age. Journal of the American Medical Association 242: 2572–2577, 1979CrossRefGoogle Scholar
  14. Institute of Medicine. Improving the quality of care in nursing homes. Committee on Nursing Home Regulations, Academy Press, Washington, DC, 1986Google Scholar
  15. Jahningen D, Hannon C, Laxson L. Iatrogenic disease in hospitalized elderly veterans. Journal of the American Geriatrics Society 30: 387–390, 1982Google Scholar
  16. Jencks SF, Clauser SB. Managing behaviour problems in nursing homes. Journal of the American Medical Association 265: 520–523, 1991Google Scholar
  17. Lamy PP. Patterns of prescribing and drug use. In Butler & Beam (Eds) The aging process: therapeutic implications, pp. 53–82, Raven Press, New York, 1985Google Scholar
  18. Lamy PP. The elderly and drug interactions. Journal of the American Geriatrics Society 34: 586–592, 1986PubMedGoogle Scholar
  19. Lamy PP. Adverse drug effects. Clinics in Geriatric Medicine 6: 293–307, 1990PubMedGoogle Scholar
  20. Lamy PP. Physiological changes due to age: pharmacodynamic changes of drug action and implications for therapy. Drugs & Aging 1: 385–404, 1991CrossRefGoogle Scholar
  21. Lamy PP, Lesko LJ. Altered drug action in the elderly. In Bailey (Ed.) Annual Reports of Medicinal Chemistry 20: 295–303, 1985CrossRefGoogle Scholar
  22. Lamy PP, Michocki RJ. Medication management. Clinics in Geriatric Medicine 4: 623–638, 1988PubMedGoogle Scholar
  23. Liang J, Jow-Ching TU E. Estimating life time risk of nursing home residency. A further note. Gerontologist 26: 560–563, 1986PubMedCrossRefGoogle Scholar
  24. McConnel CE. A note on the lifetime risk of nursing home residency. Gerontologist 24: 193–198, 1985CrossRefGoogle Scholar
  25. Medical Research Council Working Party. MRC trial of mild hypertension: principal results. British Medical Journal 291: 197–204, 1985CrossRefGoogle Scholar
  26. National Disease and Therapeutic Index. A medical profile of the over-65 population. IMS America, Plymouth Meeting, Philadelphia, 1991Google Scholar
  27. Omnibus Budget Reconciliation Act of 1987. Public Law 100–203, Sections 4201(a), 4211(b), 1987Google Scholar
  28. Ray WA, Federspiel CF, Schaffner W. A study of antipsychotic drug use in nursing homes: epidemiological evidence suggesting misuse. American Journal of Public Health 70: 485–491, 1980PubMedCrossRefGoogle Scholar
  29. Schnall P, Alderman MH, Kern R. An analysis of the HDFP trial. Evidence of adverse effects of antihypertensive therapy on white women with moderate and severe hypertension. New York State Journal of Medicine 84: 299–301, 1984PubMedGoogle Scholar
  30. SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension: final results of the systolic hypertension in the elderly program. Journal of the American Medical Association 265: 3255–3264, 1991CrossRefGoogle Scholar
  31. Sonnefeld ST, Waldo DR, Lemieux JA, McKusick DR. Projections of national health expenditures through the years 2000. Health Care Financing Review 13: 1–15, 1991PubMedGoogle Scholar
  32. Steele K, Gertman PM, Crescenzi C, Anderson J. Iatrogenic illness on a general medical service at a university hospital. New England Journal of Medicine 304: 638–642, 1981CrossRefGoogle Scholar
  33. Svarstad BL, Mount JK. Nursing home resources and tranquillizer use among the institutionalized elderly. Journal of the American Geriatrics Society 39: 869–875, 1991PubMedGoogle Scholar
  34. Van Nostrand J. Long-term care in the United States: issues in measuring nursing home outcomes. Proceedings of the 1988 international symposium on data on aging. Vital and Health Statistics, Series 5, no. 6, pp. 189–193 National Center for Health Statistics, Hyattsville, Maryland, 1991Google Scholar

Copyright information

© Adis International Limited 1993

Authors and Affiliations

  • Peter P. Lamy
    • 1
  1. 1.School of MedicineUniversity of Maryland at BaltimoreBaltimoreUSA

Personalised recommendations