Centrally active prescribing for nursing home residents - how are we doing?

IntroductionOlder patients in nursing homes are more likely to be prescribed multiple drugs than other age groups as multimorbidity is the norm. This clinical study reviewed all prescribed centrally active medications for residents in a nursing home in Dundee. Subsequent analysis was carried out to examine whether particular patient criteria are associated with an exposure to centrally acting drugs and to examine the adequacy of analgesia for care home residents.MethodsThe study was carried out in a Dundee nursing home with two different units with varying admission criteria. The research team reviewed patient records establishing background patient characteristics and medical diagnoses where psychoactive prescribing may be appropriate. In addition, information on specific prescribed medications, patient pain scores (PAINAD system), quantified cognition (6CIT score) was gathered. The non-parametric Mann Whitney U test (P < 0.05) was used to compare exposure to CNS active medications between nursing home floors.ResultsPatients with dementia in nursing homes are particularly likely to have bodily pain, insomnia and unipolar depression. Patients with more severe dementia were statistically more likely to be exposed to CNS active medications (P-value = 0.01). Importantly, despite being exposed to significant levels of psychoactive prescribing this patient group may be undertreated for chronic pain.ConclusionCentrally active prescribing in the community for geriatric patients remains high and may be associated with patient risk. Furthermore, despite this patients may be undertreated for pain syndromes.