Medication use in residential care facilities for the elderly

OBJECTIVE: To describe medication use by residents of residential care faci lities for the elderly (RCFEs), DESIGN: A cross-sectional survey of medicat ion use. SETTING: Licensed, private RCFEs recruited from a roster of all licensed RC FEs in the Los Angeles area. SUBJECTS: Residents who were greater than or equal to 60 years of age and w hose medications were centrally stored in the facility. MEASURES: Age, gender, race, health insurance coverage, dietary restriction s, ambulation status, medical diagnoses, and medication profile. RESULTS: A total of 818 residents were surveyed, Residents were primarily w hite women who were > 80 years. The average number of medications per resid ent was five; 94 % of the sample took at least one medication. Cardiovascul ar drugs, central nervous system drugs, analgesics, diuretics, and potassiu m supplements were most commonly used. Use of multiple drugs within a thera peutic class was also common, with means ranging from 1.46 to 1.81 per resi dent for the most commonly prescribed classes. Diagnoses supporting the use of many medications were not documented in the residents' health records. CONCLUSIONS: This RCFE sample was medically frail and took many medications . The frequent use of cardiovascular medication reflected the prevalence of cardiac disease in the elderly. The frequency of psychotropic drug use wit hout a corresponding indication suggested prescribing for symptoms rather t han documented medical conditions. Lack of recorded diagnoses limited the a bility to evaluate drug therapy. Improved record keeping; periodic medicati on review; and resident, staff, and prescriber education are necessary to e nsure appropriate medication use in this setting.