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Prescribed medicines for elderly frail people with diabetes resident in nursing homes : issues of polypharmacy and medication costs

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Gadsby, Roger, Galloway, Mark, Barker, Peter and Sinclair, Alan (Alan J.). (2011) Prescribed medicines for elderly frail people with diabetes resident in nursing homes : issues of polypharmacy and medication costs. Diabetic Medicine, Vol.29 (No.1). pp. 136-139. ISSN 0742-3071

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Official URL: http://dx.doi.org/10.1111/j.1464-5491.2011.03494.x

Abstract

Aims To describe the numbers and costs of medications prescribed to people living with diabetes resident in nursing homes in one primary care trust in the UK. Methods A retrospective case notes review of 75 people with known diabetes who were resident in the 11 nursing homes in the Coventry teaching primary care trust. Results Sixty-three residents (84%) were being prescribed four or more medications. Forty-four residents (59%) were prescribed anti-platelet drugs for prevention of cardiovascular disease, including aspirin, clopidogrel and dipyridamole, and 31 residents (41%) were on statin therapy. Eighteen (24%) residents had a monthly medication cost that was above 101 pound per month. On detailed review, these were largely residents who were being prescribed special order liquid preparations, usually for secondary cardiovascular disease prevention. Conclusion Polypharmacy, defined as taking four or more drugs per day per resident, is highly prevalent within this population of care home residents with diabetes. A high proportion of residents are prescribed drugs for cardiovascular disease prevention, which may be entirely inappropriate in this population with limited life expectancy. Regular medication review of care home residents with diabetes should be undertaken as it has the potential to reduce costs, minimize adverse drug reactions and increase health gain.

Item Type:

Journal Article

Subjects:

R Medicine > RC Internal medicine

Divisions:

Faculty of Medicine > Warwick Medical School

Library of Congress Subject Headings (LCSH):

Diabetes -- Treatment -- England -- Coventry, Nursing home patients -- England -- Coventry, Older people -- Medical care -- England -- Coventry, Polypharmacy

Journal or Publication Title:

Diabetic Medicine

Publisher:

Blackwell

ISSN:

0742-3071

Official Date:

2011

Dates:

Date	Event
2011	Published

Volume:

Vol.29

Number:

No.1

Page Range:

pp. 136-139

Identification Number:

10.1111/j.1464-5491.2011.03494.x

Status:

Peer Reviewed

Publication Status:

Published

Access rights to Published version:

Open Access

Funder:

Novo Nordisk, Takeda UK (Firm)

References:

1 Payne RA, Avery AJ. Polypharmacy: one of the greatest prescribing challenges in general practice (editorial) BJGP 2011; 61: 83-84
2 Junius-Walker U, TheileG, Hammers-Pradier E. Prevalence and predictors of polypharmacy among older primary care patients in Germany. Fam Practice 2007; 24:14-19
3 Garfinkel D, Mangin D. Feasability Study of a Systematic Approach for Discontinuation of Multiple Medications in Older Adults. Arch Int Med 2010; 170: 1648-1654
4 Law DT, Kasper JD, Potter DEB et al Hospitalization and death associated with potentially inappropriate medication prescriptions among elderly nursing home residents Arch Int Med 2005; 165:68-74
5 Mangin D, Sweeney K, Heath I. Preventive healthcare in elderly people needs rethinking BMJ 2007; 335: 285-287
6 Bouillet B, Villant G, Petit J-M et al Are elderly patients with diabetes being overtreated in French long-term care homes Diabetes & Metabolism 2010; 37:272-277
7 Sjoblem P, Tengblad A, Lofgren U-B et al. Can diabetes medication be reduced in elderly patients? An observational study of diabetes drug withdrawl in nursing home patients with tight glycaemic control Diab Res & Clin Practice 2008; 82: 197-201.
8 Manley S , Gough S and Stratton I (editors) HBA1c and Diabetes : Case studies using IFCC units Wiley-Blackwell publishers 2010 ISBN 10-1444334441
9. Abdelhafiz AH, Sinclair AJ. Hypoglycaemia in residential care homes. Br J Gen Pract. 2009 January 1; 59(558): 49–50
10 Gadsby R, Sinclair A, Barker P. People Living with Diabetes in Nursing Homes – Assessing levels of disability and Nursing Need Diabetic Medicine 2011 (in press)

URI:

http://wrap.warwick.ac.uk/id/eprint/41932

Data sourced from Thomson Reuters' Web of Knowledge

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