[MEDICATIONS DEPRESCRIBING IN ELDERLY NURSING HOME RESIDENTS].

INTRODUCTION: Polypharmacy, inappropriate prescribing and adverse drug reactions are frequent and important among elderly nursing home residents. Few clinical trials have evaluated systematic withdrawal of medications in nursing homes. OBJECTIVES: To compare the effect of a controlled deprescribing intervention against the usual care in elderly nursing home residents. METHODS: The present deprescribing intervention was conducted in two departments at the Shfaram Geriatric Center (Beet Alenaya). Two departments at the "Hemdat Avot" nursing home were the control arm. The intervention was a withdrawal or stepwise tapering of a target medication. The main outcome was the number of participants in whom medication withdrawal or tapering could be achieved. RESULTS: A total of 55 participants completed the intervention and follow-up. The results showed that 65.5 % of the intervention group had discontinued a medication use compared with 27% of the control group (risk difference, 73% [95%CI, 58%-85%]; intracluster correlation, 0.001; number needed to treat, 2.60). Dose reduction occurred in an additional 11%. In multivariate sub-analyses, age greater than 80 years, sex and concomitant polypharmacy (10 drugs or more per day) did not have a significant interaction effect with medication therapy discontinuation. CONCLUSION: A controlled deprescribing intervention in nursing homes was feasible and acceptable to participants. Such interventions should be further evaluated in larger randomized controlled trials.

[The effect of an intervention on rates of nursing home residents transfers to emergency departments].

INTRODUCTION: Transfers of nursing home residents to emergency departments can result in iatrogenic complications, morbidity, and excess health care expenditure. Some of these transfers are potentially avoidable. OBJECTIVES: To determine the rate of emergency department transfers of nursing home residents, prior to and following an intervention program that includes a set of tools and strategies designed to reduce these transfers. METHODS: The present study was conducted in four departments at the Shfaram Geriatric Center (Beet Alenaya). The rate of emergency department transfers was determined in 118 residents of the nursing home during the 12 months prior to and during the 12 months following implementation and initiation of the intervention. RESULTS: Following the intervention, a significant reduction in the rate of emergency department transfers was observed in the study population from 2.61 to 1.28 transfers per 1,000 stay days, with a 50.1% transfer reduction (P < 0.005). The most significant reduction was observed among residents staying in the Complex Nursing Care Department (54.7%)(P < 0.05). The reduction rate among long term nursing care residents was modest (20.3%) and did not reach statistical significance. CONCLUSION: The implementation of such an intervention can reduce the rate of transfers of nursing home residents to emergency departments. Such interventions might lead to quality improvement in nursing homes and should be further evaluated in larger randomized controlled trials.