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Pharmacy
Special Issues
Quality Use of Medicine in Aged Care Homes
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Quality Use of Medicine in Aged Care Homes

A special issue of Pharmacy (ISSN 2226-4787).

Deadline for manuscript submissions: closed (30 November 2019) | Viewed by 12638

Special Issue Editor

Dr. Sam Kosari

E-Mail Website
Guest Editor
Discipline of Pharmacy, Faculty of Health, University of Canberra, Bruce, ACT 2617, Australia
Interests: quality use of medicines; aged care; medication safety; pharmacists in aged care; pharmacists in general practice; medication adherence; pharmacoeconomics; pharmacy education; health service optimisation

Special Issue Information

Dear Colleagues,

The number of people older than 65 years will rise to approximately 16% of the world population by 2050. This ageing population has produced increased demand on the healthcare system, resulting in an increased number of people receiving residential aged care services. Older adults residing in aged care homes are often diagnosed with multiple chronic diseases and require multiple medications to manage their health‐related conditions. The majority of residents in aged care homes are exposed to polypharmacy that places them at a higher risk of drug interactions, adverse drug reactions, and medication errors, and increases morbidity, mortality, and complexity of care.

Recent studies report a concerning rate of medication-adverse events in aged care homes, the causes of which are likely to be multifactorial. Besides polypharmacy, other important factors that are responsible for medication-adverse events and play roles in the quality use of medicine in aged care homes include nursing staff education; aged care homes medication management policies and procedures; the extent of interdisciplinary collaboration between the service providers; and access to health professionals such as GPs, pharmacists, and specialists.

This Special Issue aims to share findings on different aspects of the quality use of medicine in aged care homes including

  • the scope, impact, and spread of the issue
  • strategies to improve the medication management system
  • interventions resulting in optimising medications
  • interprofessional practice
  • deprescribing
  • polypharmacy
  • the impact of collaborative pharmacists/pharmacy services and
  • training and education

Dr. Sam Kosari
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Pharmacy is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • quality use of medicine
  • aged care home
  • nursing home
  • long-term care facilities
  • medication management system
  • medication optimization
  • medication review
  • pharmacist
  • polypharmacy
  • deprescribing
  • interprofessional practice

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Published Papers (3 papers)

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Research

10 pages, 263 KiB  
Article
Anticholinergic Burden, Sleep Quality and Health Outcomes in Malaysian Aged Care Home Residents
by Suresh Kumar, Syed Shahzad Hasan, Pei Se Wong, David Weng Kwai Chong and Therese Kairuz
Pharmacy 2019, 7(4), 143; https://doi.org/10.3390/pharmacy7040143 - 23 Oct 2019
Cited by 10 | Viewed by 3354
Abstract
The use of anticholinergic medications by residents in aged care homes is associated with increased risk of adverse effects. These include cognitive impairment, sleep disturbances, and falls, and necessitate increased healthcare visits and the associated burden on healthcare systems. The objective of this [...] Read more.
The use of anticholinergic medications by residents in aged care homes is associated with increased risk of adverse effects. These include cognitive impairment, sleep disturbances, and falls, and necessitate increased healthcare visits and the associated burden on healthcare systems. The objective of this study was to investigate associations between anticholinergic burden and health outcomes such as independence in activities for daily living, frailty, quality of life, and sleep quality. The study was conducted among residents in Malaysian aged care homes, aged 60 years and above. Anticholinergic burden was calculated using the Anticholinergic Cognitive Burden (ACB) scale. Health outcome measures included independence, assessed using the Katz Activities for Daily Living scale (Katz ADL); quality of life, assessed using the Older People’s Quality of Life Questionnaire (OPQOL); frailty, assessed using the Groningen Frailty Index (GFI); and sleep quality, measured using the Pittsburg Sleep Quality Index (PSQI). Just over one-third (36%) of the study population was exposed to at least one medication with anticholinergic effect. An increased anticholinergic cognitive burden was associated with frailty (p = 0.031), sleep latency (p = 0.007), and sleep disturbances (p = 0.015). Further studies are required to assess the effect of prolonged exposure to anticholinergic medications on health outcomes. Full article
(This article belongs to the Special Issue Quality Use of Medicine in Aged Care Homes)
11 pages, 907 KiB  
Article
Reduction in Use of Risperidone for Dementia in Australia Following Changed Guidelines
by Lisa M Kalisch Ellett, Anna K Moffat, Svetla Gadzhanova, Nicole L Pratt, Jemisha Apajee, Michael Woodward and Elizabeth E Roughead
Pharmacy 2019, 7(3), 100; https://doi.org/10.3390/pharmacy7030100 - 22 Jul 2019
Cited by 6 | Viewed by 5097
Abstract
Background: Risperidone is the only antipsychotic approved in Australia for the management of the behavioural and psychological symptoms of dementia (BPSD). In June 2015, the Australian Government Therapeutic Goods Administration (TGA) amended the indication to restrict use in BPSD to patients with Alzheimer’s [...] Read more.
Background: Risperidone is the only antipsychotic approved in Australia for the management of the behavioural and psychological symptoms of dementia (BPSD). In June 2015, the Australian Government Therapeutic Goods Administration (TGA) amended the indication to restrict use in BPSD to patients with Alzheimer’s dementia for a maximum twelve-week duration. We aimed to determine whether the rate and duration of risperidone use for BPSD decreased following the regulatory changes. Methods: we conducted a study using the Australian Government Department of Veterans’ Affairs administrative claims data and Pharmaceutical Benefits Scheme (PBS) 10% sample data. We included people aged 65 years or older and compared the rate and duration of risperidone use before and after the TGA labelling changes. Results: There was a sustained decrease in the trend of risperidone use for BPSD following the TGA labelling changes, with a monthly decrease of 1.7% in the aged care population, 0.5% in the community living population and 1.5% in the general older Australian population. Overall, in the 24 months post the TGA changes the reduction in the rate of use of risperidone ranged from 20% to 28% lower than compared to what the rate would have been without the TGA changes. The median duration of use of risperidone in aged-care residents decreased from 338 days in the year prior to the TGA labelling changes, to 240 days per person in the year after the changes. Conclusion: The TGA labelling changes were associated with a significant reduction in the rate of use of risperidone for BPSD in veterans living in both the aged care and community settings, and in the general older Australian population. The labelling changes were also associated with a reduced duration of risperidone use in aged care residents, although for most people the duration of use still exceeded the recommended 12-week maximum duration. Full article
(This article belongs to the Special Issue Quality Use of Medicine in Aged Care Homes)
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11 pages, 225 KiB  
Article
Prevalence and Duration of Use of Medicines Recommended for Short-Term Use in Aged Care Facility Residents
by Lisa M. Kalisch Ellett, Gizat M. Kassie, Nicole L. Pratt, Mhairi Kerr and Elizabeth E. Roughead
Pharmacy 2019, 7(2), 55; https://doi.org/10.3390/pharmacy7020055 - 6 Jun 2019
Cited by 6 | Viewed by 3721
Abstract
Background: Multiple studies have assessed the appropriateness of the use of medicines for nursing home residents; however, few have included duration of use in their assessment. The aim of this study was to assess the level and duration of use of medications [...] Read more.
Background: Multiple studies have assessed the appropriateness of the use of medicines for nursing home residents; however, few have included duration of use in their assessment. The aim of this study was to assess the level and duration of use of medications recommended for short-term use in residents of aged care facilities in Australia. Methods: Australian Government Department of Veterans’ Affairs (DVA) administrative claims data were used for this study. Veterans eligible for all health services subsidised by DVA were followed for one year from 1 July 2015 to 30 June 2016. The number of days covered for each medicine was calculated by multiplying the number of prescriptions dispensed during the year by the pack duration for the medicine. The pack duration was calculated by dividing the quantity supplied at each dispensing by the usual number of doses per day in older people according to Australian prescribing guidelines. The proportion of patients using each medicine and the number of days covered during the study period were determined. Results: 14, 237 residents met the inclusion criteria. One in five participants were dispensed antipsychotics, and the median duration of use was 180 days in the one-year period. More than one-third were dispensed a benzodiazepine, and the median duration of use was 240 days in the year. Half were dispensed an opioid analgesic with a median duration of use of 225 days in the year. Fifty-two percent were dispensed proton pump inhibitors with a median duration of use of 360 days in the year. A quarter received an antibiotic recommended for the management of urinary tract infection, with a median duration of use of 14 days in the year. Conclusion: Long-term use of antipsychotics, benzodiazepines, opioid analgesics and proton pump inhibitors is common in aged care residents. Ensuring appropriate duration of use for these medicines is necessary to reduce risk of harm. Full article
(This article belongs to the Special Issue Quality Use of Medicine in Aged Care Homes)
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