Interventions to optimize prescribing for older people in care homes

In 2017, the United Nations reported that the world's population aged 60 years and over was 962 million people, over twice as many older persons than was reported in 1980. This number is expected to double again by 2050, reaching nearly 2.1 billion older persons. Within this projection, the number of persons aged 80 years or over will increase more than threefold, increasing from 137 million to 425 million (United Nations, 2017). Growing old is often accompanied by a higher prevalence of medical conditions which can result in the development of moderate to severe functional and/or cognitive impairments to the extent that long‐term accommodation and care is needed. According to the Organization for Economic Cooperation and Development (OECD, 2017), across their participating countries, there is on average 46 long‐term care beds per 1000 people aged 65 years and over. Prevention and management of medical conditions and comorbidities typically requires the use of medicines leading to often complex regimes. Polypharmacy, where four or more different medicines are prescribed, may be the unintended consequence. Polypharmacy can be appropriate and necessary, but inappropriate polypharmacy is common in this population. Underprescription may also be a concern, for example, pain medicines for a person unable to express themselves. Prescribing is further complicated by age‐related changes that influence how drugs move around the body and how this impacts on the therapeutic effects of drugs (Kim & Luck Parish, 2017). Nurses caring for older people in care homes play a vital role in the optimization of medicines. As part of a multidisciplinary team, nurses are in the position to closely assess, monitor, and report the need for medicines and any potential or real adverse outcomes of already prescribed medicines (Halvorsen, Stensland, & Granas, 2011). Nurses need to know about evidence‐based interventions to optimize prescribing and the quality of the evidence given the frailty and vulnerability of older people residing in care homes