Educationally intervening the use of potentially harmful medication among residents in institutional settings

Abstract Educationally intervening the use of potentially harmful medication among residents in institutional settings Institutionalized older people are frail, they suffer from a high number of comorbidities, and polypharmacy is common among them. They are prone to adverse effects of drugs. Aim of this study was to explore the use of potentially harmful medications (PHMs) among older people living in assisted living facilities in Helsinki (Studies 1-4) and nursing homes in Kouvola (Study 1). Study 1 was a cross-sectional study investigating burden and overlapping of PHMs according to three criteria (drugs with anticholinergic properties, use of Beers’ criteria medications, and concomitant use of >2 psychotropics). Proportion of using any PHMs was 79%. Burden of PHMs was associated with lower health-related quality of life (HRQoL), poorer self-rated health, and lower psychological well-being (PWB), but not with increased 3-year mortality. Studies 2-4 were based on a randomized controlled trial (RCT) with educational intervention. Nurses in intervention units received 2x4 hour education in older people medication, both harmful and beneficial. Learning was interactive and problem-based. Nurses brought their residents’ medication problems to treating physicians, who made the changes in medication. As a result of intervention, the mean number of PHMs, especially psychotropics, decreased in intervention wards compared to control wards. Residents in intervention wards had significantly less hospital days/year (relative risk RR 0.60, 95% confidence interval (CI) 0.49 to 0.75; p<0.001), and falls (incidence rate ratio IRR 0.72, 95% CI 0.59 to 0.88; p