Multiple Medication Use for Nursing Home Residents May Have Pros and Cons Like a Two-sided Coin
New research from the recently published journal Circulation: Cardiovascular Quality and Outcomes addresses the pros and cons of multiple medication use for nursing home residents. The study points out that while taking multiple medications may increase a resident’s probability for survival after a heart attack, it may reduce a resident’s ability to perform daily activities safely. Taking that into consideration is important for making decisions regarding quantity versus quality of life.
According to the study’s author, “Using more medications to prevent another heart attack may be useful for vulnerable older adults who wish to live longer; however, since using more medications may interfere with older adults’ ability to do their daily activities, more medications should not be taken by older adults who wish to maintain their independence and daily functioning, rather than live longer.”
Other physicians agreed that because elderly residents are often quite frail, the decision about giving multiple medications is tricky. There is “a fine line between providing lifesaving and necessary medication and frailty.” Consequently, the decision is very patient-specific, and part of the conversation with these residents should address quality of life.
The benefit of using multiple medications, according to the study, seemed to be limited to three pills. However, it was also pointed out that the study could not prove that taking three or more medications was a direct cause of lowered daily function.
One cardiologist made this statement, “Quality of life and patient preference are paramount at this age and functional status, so physicians must understand the wishes of the patient and family, and discuss individual goals and expectations of therapy.”
Compliance Perspective
Failing to inform residents/responsible parties and include them in making treatment decisions that might extend their lives but cause decreased ability to perform daily activities, may be a violation of residents’ rights and federal regulations for avoiding unnecessary drugs.
Discussion Points:
- Review policies and procedures regarding developing and implementing comprehensive care plans and including residents/responsible parties in treatment decisions that may prolong life but reduce quality of life.
- Train staff to recognize changes in residents’ conditions regarding their ability to perform daily activities when the number of medications they receive are increased.
- As part of your medication management activities, periodically audit to determine if residents’ ability to perform daily activities of living is affected as the number of their medications increases.
