Cochrane Summaries

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Interventions to optimise prescribing for older people in care homes

Alldred DP, Raynor DK, Hughes C, Barber N, Chen TF, Spoor P
Published Online: 
28 February 2013

Older people living in care homes (also called nursing homes, residential homes, skilled-nursing facilities, assisted-living facilities or aged-care facilities) have many complex physical and mental health problems. Care home residents are prescribed many medicines compared to people who live in their own homes, with an average of eight medicines being common. International research has shown that these medicines are often not well managed, with some residents prescribed medicines inappropriately. This has the potential to lead to harmful side effects and a loss of benefit. For these reasons, it is important to make sure that care home residents are prescribed the right medicines at the right doses.

This review found eight studies involving 7653 residents in 262 care homes in six countries that evaluated interventions to optimise prescribing for care home residents. Most of the interventions had several components, often involving a review of medicines with a pharmacist and doctor. Some interventions included a teaching component and one study used Information Technology.

There was no evidence of benefit of the interventions with respect to reducing adverse drug events (harmful effects caused by medicines), hospital admissions or death. None of the studies looked at quality of life. Problems relating to medicines were found and addressed through the interventions used in the studies. Prescribing was improved based on criteria used to assess the appropriateness of prescribing in two studies.

More high-quality studies need to be done to gather more evidence for these and other types of interventions. Further studies are needed to evaluate new technologies, including computer systems that support prescribing decisions.  More work needs to be done to make sure that researchers are consistently measuring outcomes that are important to care home residents.