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06 Optimising the medication of elderly persons living in nursing homes

 

Elderly persons living in nursing homes often take potentially inappropriate medication. Stopping or reducing doses of medication – referred to as deprescribing – can improve their health and quality of life. This study seeks to develop an interprofessional approach to deprescribing in nursing homes.

Portrait / project description (ongoing research project)

The exploratory phase consists in analysing existing Vaud and Fribourg data to evaluate the proportion of treatments that could be optimised in nursing homes. The acceptance level and feasibility of a deprescribing process will also be studied. An intervention phase will then assess the effectiveness of a two-stage process by means of a randomised, controlled study. The first stage will involve adapting the prescription profile of doctors based on the approach already used by interprofessional quality circles. In a second stage, pharmacists will propose additional medication reviews in more complex cases to be carried out in agreement with the residents, the nurses and the physicians.

Background

The health status of elderly persons in nursing homes is fragile, while their medication is often complex. In nursing homes in the cantons of Vaud and Fribourg, an innovative form of collaboration involving nurses, physicians and pharmacists has for many years shown potential for containing costs of medicines. This approach, built on interprofessional trust, is a useful means of studying the opportunities and limits of deprescribing to optimise medication effectiveness and safety in nursing homes.

Aim

The study proposes to develop and validate an interprofessional deprescribing process that will optimise the medication regimen of nursing home residents. It aims to maximise medication appropriateness and safety. This will be done by analysing the effects of such a process on residents’ medication, their general health status and their quality of life. It will also evaluate the financial and organisational feasibility of the process and its acceptance among the persons involved.

Relevance / Application

This study will allow practice recommendations and procedures for deprescribing in nursing homes to be developed and validated in order to optimise residents’ medication. Benefiting from the positive interprofessional experience of the cantons of Fribourg and Vaud, the knowledge obtained from this study will be replicable in other cantons and will be extended to other situations (discharge from hospital) or patients (elderly persons living at home) who are particularly at risk of drugs related problems.

Original title

Opportunities and limits of deprescribing for older people in nursing homes (OLD-NH)

Project leaders

Applicant:

  • Prof. Olivier Bugnon, Section des sciences pharmaceutiques, Pharmacie Communautaire, Université de Genève, Université de Lausanne

Co-applicant:

  • Dr. Anne Niquille, Policlinique Médicale Universitaire, Université de Lausanne

Project partners:

  • Dr. Pierluigi Ballabeni, Institut universitaire de médecine sociale et préventive, Faculté de biologie et médecine, Université de Lausanne
  • Dr. Clémence Perraudin, Centre de Pharmacie Communautaire, Section des sciences pharmaceutiques, Université de Genève, Université de Lausanne
  • Prof. Rose-Anna Foley, Haute Ecole de Santé Vaud (HESAB), Unité de recherché en santé, Haute Ecole Spécialisée de Suisse occidentale (HES-SO)
  • Dr. Pierre-Olivier Lang, Service de gériatrie et réadaptation gériatrique, Faculté de biologie et médecine, Université de Lausanne

 

 

Further information on this content

 Contact

Dr. Anne Niquille PMU | Policlinique Médicale Universitaire Rue du Bugnon 44 1011 Lausanne +41 79 556 37 97 anne.niquille@unisante.ch

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