(De)Prescribing In Nursing Home Residents

Among older adults, multimorbidity is common and frequently leads to polypharmacy, typically defined as the concurrent use of five or more medications. In the absence of age-specific prescribing guidelines, several strategies have emerged to improve medication use in older populations, including the concept of deprescribing, which was first introduced in 2003. Polypharmacy is particularly prevalent among nursing home residents and has been consistently associated with adverse clinical outcomes. In this context, medication review has been promoted as a structured and systematic approach to optimize pharmacotherapy by identifying and resolving drug-related problems.

We have built upon these insights by conducting a series of studies focusing on medication use among frail nursing home residents across multiple European countries, representing diverse healthcare systems and clinical populations. Medications were systematically assessed for (in)appropriateness, and, in addition, we explored the attitudes and perspectives of Elderly Care Specialists (ECSs) in the Netherlands regarding prescribing and deprescribing practices. By integrating quantitative epidemiological analyses with qualitative insights from clinical practice, we obtained a comprehensive understanding of current prescribing patterns, decision-making processes, and perceived challenges. We have focused in this thesis on the prescribing of potentially inappropriate medications (PIMs) in nursing home residents, with particular attention to clinical patterns, patient safety, and contextual factors influencing rational medication use. Central to this work is the role of the Elderly Care Specialist, a physician uniquely trained in the Netherlands to manage complex chronic conditions in long-term care settings by combining biomedical expertise with person-centered care principles. Specifically, we assessed the prevalence of PIMs across European countries, examined patterns of preventive cardiovascular and osteoporosis medication prescribing in relation to resident characteristics and national context, and investigated the barriers and facilitators influencing deprescribing decisions among Elderly Care Specialists.

We have applied the SEXTUPLE framework specifically to structure the discussion of prescribing and deprescribing practices, guiding the analysis of key patterns, barriers, and facilitators from the perspective of clinicians, while the empirical studies themselves were conducted using standard quantitative and qualitative methods. […]