DRUG-USE IN THE NURSING-HOME

Some of the most intensive pharmacotherapy today occurs in nursing hom es in very complex and vulnerable patients. The nursing home provides an opportunity for highly effective drug use, but it also presents ris ks for polypharmacy and adverse events. Nursing homes are complex soci al institutions, in which physicians, nurses, consultant pharmacists, other health care professionals, aides, and administrators must intera ct to make decisions about drug use for patients who generally are fra il and have numerous comorbid conditions. Federal regulations have rec ently been implemented to direct the ways in which specific drugs are to be used in this setting. The nursing home environment can present a n ideal opportunity for comprehensive drug regimen review, an exercise too often neglected in the care of elderly patients in all clinical s ettings. Psychoactive medications, analgesics, and laxatives are examp les of drugs that should receive such review. The possible underuse of drug therapies that may be beneficial to nursing home residents, incl uding antidepressant, antihypertensive, and antithrombotic agents; cal cium supplements; and vaccines, must be further quantified and must re ceive increased attention. Morbidity and functional incapacity can be substantially reduced by applying currently established principles of geriatric pharmacology in the nursing home setting, but enormous gaps still exist in the knowledge base necessary to guide this aspect of ge riatric medical practice. Data on the efficacy, toxicity, and cost-eff ectiveness of pharmacotherapeutic choices in nursing home patients are in short supply; considerably more clinical and epidemiologic researc h is needed to define the relations between the benefits and risks of drugs for this unique population.