Original Articles

The War Against Polypharmacy: A New, Cost-Effective, Geriatric-Palliative Approach for Improving Drug Therapy in Disabled Elderly People

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Click on the icon on the upper right hand side for the article by Doron Garfinkel, MD, Sarah Zur-Gil, MA and Joshua Ben-Israel, MD, Department of Evaluation & Rehabilitation Pharmacy and Directorate, Shoham Geriatric, Medical Center, Pardes Hana, Israel.
IMAJ 2007: 9: June: 430-434
Abstract

Background: The extent of medical and financial problems of polypharmacy in the elderly is disturbing, particularly in nursing homes and nursing departments.


Objectives: To improve drug therapy and minimize drug intake in nursing departments.


Methods: We introduced a geriatric-palliative approach and methodology to combat the problem of polypharmacy. The study group comprised 119 disabled patients in six geriatric nursing departments, and the control group 71 patients of comparable age, gender and co-morbidities patients in the same wards. After 12 months, we assessed whether any change in medications affected the death rate, referrals to acute care facility and costs.


Results: A total of 332 different drugs were discontinued in 119 patients (average of 2.8 drugs per patient) and was not associated with significant adverse effects. The overall rate of drug discontinuation failure was 18% of all patients and 10% of all drugs. The 1 year mortality rate was 45% in the control group but only 21% in the study group (P < 0.001, chi-square test). The patients’ annual referral rate to acute care facilities was 30% in the control group but only 11.8% in the study group (P < 0.002). The intervention was associated with a substantial decrease in the cost of drugs.


Conclusions: Application of the geriatric-palliative methodology in the disabled elderly enables simultaneous discontinuation of several medications and yields a number of benefits: reduction in mortality rates and referrals to acute care facilities, lower costs, and improved quality of living.