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Cut medications for patients in care homes, GPs told

More than 80% of elderly patients with diabetes in care homes are taking multiple medications, many of them ‘inappropriately' prescribed for cardiovascular prevention, a new study reports.

Prescribing costs could be halved for some patients in care homes if unnecessary medications were stopped and liquid preparations replaced by crushed tablets, the researchers claimed.

Their study looked at medications taken by 75 elderly residents of nursing homes with diabetes in the Coventry area.

They found 84% were taking four or more medications, meeting the definition of polypharmacy, and more than a third were prescribed eight or more drugs.

Much of this treatment was to prevent cardiovascular disease, with antiplatelets given to 59% and statins to 41%.

The authors focused on 18 residents whose monthly drug costs were over £101 per month, with the high costs mostly due to special-order liquid preparations, which can cost up to 50 times more than standard oral tablets. Liquids were prescribed because the patient had swallowing difficulties or was fed by percutaneous endoscopic gastrostomy.

Study leader Professor Roger Gadsby, senior lecturer at Warwick Medical School, said these expensive medications could be stopped, following review, when no longer of clinical benefit.

He said: ‘Given the disability and nursing need described in this group of residents, it could be concluded cardiovascular disease prevention therapy is inappropriate and is unlikely to have any benefit in prolonging or enhancing life.'

‘It is not unreasonable to suggest medication changes resulting in at least a 50% reduction in the prescription costs for this group of residents would be possible.'

If similar changes were made nationally, there could be a saving of £10 to £12 million, he added.

Dr Clive Henderson, a GP in Market Weighton, East Yorkshire, said polypharmacy in elderly patients was a serious problem: ‘Most drugs like statins that we prescribe we don't have a lot of evidence for in patients in their late 80s and 90s. There are side-effects like muscle weakness and falls.'

Dr Tim Cantor, a GP in West Malling, Kent, said the cost of some liquid preparations was ‘extortionate' and alternatives were needed.

He said: ‘There are some tablets that can be safely crushed and some you can't,' he said. ‘It would be good to have some guidelines about which compounds you can do that with.'

But Dr Henderson warned crushing tablets would be an off-licence use, and doubted whether PCTs would authorise it.

 

Polypharmacy in nursing homes

Of 75 elderly nursing home patients with diabetes:

63 were prescribed four or more medications a day

26 were taking 8 to 11 medications a day

3 were taking more than 12 drugs per day

18 had monthly medication costs of over £101

Source: Diabet Med 2011, published online 17 October