USE OF DIURETICS AND OPPORTUNITIES FOR WITHDRAWAL IN A DUTCH NURSING-HOME POPULATION

Background: Diuretics are frequently used by elderly patients and over prescription has been suggested. However, the present withdrawal patte rns of these medications in clinical practice elderly patients are unc lear. Methods: Retrospective medical record analysis of all 584 patien ts aged 75 years or older admitted to a 240-bed nursing home facility in the years 1990-1994. One-year follow-up by record review and collec tion of updated information from nursing home physicians. Results: Two hundred and twenty patients (37.7%) used diuretics, and use increased with age (p < 0.05). Reported indications for prescription were heart failure (n = 77), hypertension (n = 38), ankle edema without heart fa ilure (n = 21), or not reported (n = 84). Diuretics were withdrawn in 82 of 220 patients (37.3%), but a doubtful actual indication for diure tic use was found in 72 of the remaining 138 patients (52.2%). After w ithdrawal, the probability of remaining free from diuretics for at lea st one year was 0.47. There were no reports of Life-threatening or fat al incidents after withdrawal. Mortality rates for the patients whose diuretics were withdrawn did not differ from patients continuing on di uretics. Conclusions: Withdrawal of diuretics was frequently performed and often successful. In addition, doubtful indications for diuretics were found in half of the patients continuing on these medications, s uggesting additional opportunities for diuretic withdrawal, (C) 1998 E lsevier Science B.V. All rights reserved.