Dangerous prescribing reduced with education - Rx News

Researchers found that the inappropriate and excessive prescribing of psychoactive drugs to nursing home residents is significantly reduced when doctors, and aides are educated about the risks of geriatric psychopharmacology. The educational materials used in a new study conducted at nursing homes in the Boston area resembled the slick promotional materials usually distributed by drug companies with one critical difference -- they emphasized a drug's risks for the elderly rather than its benefits (The New England Journal of Medicine, 16 July 1992).

The controlled study involved over 800 residents in 12 nursing homes, six homes randomly selected to receive the educational program and six homes that did not. Assessments of residents were made when the research began and then five months later by an observer who did not know which nursing homes had the special intervention program.

Educating staff about drug risks resulted in a 20% overall reduction in psychoactive medication use. Followup assessment in homes where medication use was reduced found residents had improved memory and cognition. There was no increase in disruptive behavior, and staff did not report greater problems in caring for residents. The latter two concerns are commonly dated by those who defend the frequency with which psychoactive drugs are prescribed in nursing homes. There was, however, an increase in residents' reports of depression.

The research team was headed by Jerry Adorn, M.D., of Harvard Medical School and Brigham and Women's Hospital, Boston, who in an earlier study found the inappropriate use of such drugs as antipsychotics, hypnotics, and antidepressants to be common in nursing homes (see HealthFacts, January 1989). Advocates consider much of the inappropriate prescribing to be the chemical equivalent of physical restraints. Furthermore, numerous studies have documented the adverse effects suffered by the elderly as a result of bad prescribing, which include an increased number of falls and fractures.

The researchers used the following prescribing practices to identify potentially inappropriate use:'

* Any use of antipsychotic drugs (most common is haloperidol, whose brand name is Haldol);

* Use of the antihistamine diphenhydramine (brand names: Benadryl and others), a drug commonly prescribed for insomnia:

* Use of long-acting benzodiazepine tranquilizers, such as diazepam (brand name: Valium), flurazepam (brand name: Dalmane), chlordiazepoxide (brand name: Librium);

* High doses of other benzodiazepines, for example, over 30 mg per day of oxazepam (brand name: Serax); .25 mg or more per day of triazolam (brand name: Halcion);

* Use of the antidepressant amitriptyline (brand name: Elavil); or

* High doses of other antidepressant drugs; for example, 50 mg or more per day of desipramine (brand name: Norpramm).

Readers can use the above as a means of identifying potentially inappropriate prescribing of drugs to family members or others residing in nursing homes. The Federal government adopted regulations in 1991 that attempt to restrict use of antipsychotic drugs in nursing homes. In addition some states have developed their own process of monitoring and correcting use of psychoactive drugs in nursing homes. For more information, contact your state health department.

COPYRIGHT 1992 Center for Medical Consumers, Inc.
COPYRIGHT 2004 Gale Group