Deprescribing In Long Term Care

Reducing Avoidable Medication-Related Health Problems Among Older Adults in Long-Term Care Settings

SUNY Upstate Departments of Geriatrics and Public Health and Preventive Medicine in Collaboration with the Loretto Health System. Funded by the New York State Health Foundation

This project addresses the opportunity to optimize the management of medications for older adults in long term care settings through deprescribing -- a physician supervised process involving ceasing, replacing or decreasing the number of unnecessary or potentially inappropriate medicines to minimize the effects of polypharmacy and prevent adverse drug events or outcomes. Unnecessary medications and adverse drug events put one in 25 older adults at risk of avoidable health problems and emergency room visits, and that as many as 95% of nursing home residents have medication related health issues.

The project was a retrospective, longitudinal pre/post impact and cost benefit evaluation of a deprescribing program introduced for long-term residents of two skilled nursing facilities (SNFs) within the Loretto Health System in Upstate New York. The two primary questions follow.

Can a systematic program for deprescribing reduce the number of medication classes prescribed for long term SNF residents and the number of high risk classes prescribed?
Do the benefits of a deprescribing program outweigh costs?

Results suggest that deprescribing efforts in SNFs can have beneficial results in reducing polypharmacy and side-effect prone medications. Loretto’s pragmatic and systematic deprescribing effort was associated with a reduction in several classes of medications, including Opioids, Antipsychotics, Antianxiety medications, and Antibiotics. Each of these classes is associated with significant side effects, and/or is the target of public health efforts to improve stewardship and reduce usage. The extended analysis also suggests that the results are sustainable at least over a period of 1-2 years.

Detailed information on project methods and findings is available at the following links.

Project Practice and Policy Brief

Senior Care Pharmacist Publication, October 1, 2022.
http://pubmed.ncbi.nlm.nih.gov/36171671/

NAPCRG 2022 Annual Meeting Presentation (Received Pearl Award)
http://www.napcrg.org/media/2173/na22_pearl_op176_retrospective-evaluation-of-a-pragmatic-deprescribing-initiative-in-a-skilled-nursing-facility-system.pptx