Professor Michael S Roberts, DSc
Julie Stokes, BPharm, PG
Dip Clin Hosp Pharm.
Department of Medicine,
University of Queensland,
Ipswich Road,
Buranda, Qld, Australia.
Introduction
One of the most professionally satisfying scenes we have observed while working in nursing homes is an older person regaining his or her dignity and independence after unnecessary drugs have been ceased. It is often easy to add medications to the drug regimen of older people1 to treat "new" conditions, some of which may in fact be the adverse effects of medications already prescribed. Drugs can cause subclinical diminution in function or their adverse effects can mimic almost any clinical syndrome.2 It has been shown that the risk and frequency of adverse drug outcomes increase with the number of drugs prescribed--some residents may be on up to 22 medicines at a given time3 and not all of these are needed. Some classes of medications, most notably psychoactive drugs, are of particular concern in nursing homes.4 In a prospective cohort study of 1106 nursing beds in 12 nursing homes in Los Angeles, Beers et al.5 suggested that 40% of the residents received at least one inappropriate medication order, 10% received two or more inappropriate medication orders concurrently, and 7% of all medications were inappropriate. A similar finding has been reported for the UK.
