Rational prescribing in geriatrics represents an important ethical as well as socio-economic issue. The aim of this project was to analyze the drug-related problems (DRPs) among the Czech nursing home residents and increase public awareness of further possible employment of clinical pharmacists in social care. The project was designed as a multicenter observational study. A total of 16 nursing homes and 800 participants with an average age of 84.6 ± 7.3 years were included in the study. Of them, a DRP was noted in 93.3% of people. The total amount of DRPs identified was 2215, which means an average of 2.8 ± 1.6 DRPs per patient. The most common DRPs identified were 'overtreatment' (19.5%), 'undertreatment' (12.8%), inappropriate dose (10.6%), recommendations for laboratory monitoring (10.4%) and adverse effects (10.3%). Of different drug classes, BZDs (OR 16.6, 95% CI 1.0-270.2), PPIs (OR 2.5, 95% CI 1.1-5.6) and NSAIDs (OR 4.4, 95% CI 1.1-18.3) were identified to be most commonly associated with DRPs. The risk of DRP identification clearly increased with the number of drugs used, with seven drugs demonstrated as the best cut-off for predicting DRP identification (AUC 0.842, sensitivity 0.602; specificity 0.796). 'SENIOR' project has confirmed a high rate of excessive polypharmacy among nursing home residents in the Czech republic resulting in high risk of potential and manifested DRPs. The project emphasized the role of clinical pharmacists in optimizing safety and effectiveness of treatment among older nursing home residents.

3 Internal Clinic Endocrinology and Metabolism General University Hospital and 1st Faculty of Medicine Prague Czech Republic

Department of Anaesthesia and Intensive Care Medicine 3rd Faculty of Medicine and FNKV University Hospital Charles University Prague Czech Republic

Department of Anaesthesia and Intensive Care Medicine 3rd Faculty of Medicine Charles University Prague Czech Republic

Department of Clinical Pharmacy Na Homolce Hospital Prague Czech Republic

Department of Pharmacology Motol University Hospital and 2nd Faculty of Medicine Charles University Prague Czech Republic

Institute of Pharmacology General University Hospital and 1st Faculty of Medicine Charles University Prague Czech Republic

Institute of the Drug Guide Prague Czech Republic

Neurointensive Care Unit Liberec Regional Hospital Liberec Czech Republic

See more in PubMed

Fialová D. and Onder G., “Medication Errors in Elderly People: Contributing Factors and Future Perspectives,” British Journal of Clinical Pharmacology 67, no. 6 (2009): 641–645, 10.1111/j.1365-2125.2009.03419.x. PubMed DOI PMC

Topinková E., Geriatrics for Practice (Galén, 2005).

Kriška M., Lašánová M., Krajčík Š., and Murín J., “Utilization of Drugs in Older Generations – Drug Risk Prevention,” Geriatria 1 (2001): 7–12.

Topinková E. and Neuwirth J., Geriatrics for the Practitioner (Grada Avicenum, 1995).

Steinman M. A., Landefeld C. S., Rosenthal G. E., Berthenthal D., Sen S., and Kaboli P. J., “Polypharmacy and Prescribing Quality in Older People,” Journal of the American Geriatrics Society 54, no. 10 (2006): 1516–1523, 10.1111/j.1532-5415.2006.00889.x. PubMed DOI

Goldberg R. M., Mabee J., Chan L., and Wong S., “Drug‐Drug and Drug‐Disease Interactions in the ED: Analysis of a High‐Risk Population,” American Journal of Emergency Medicine 14, no. 5 (1996): 447–450, 10.1016/S0735-6757(96)90147-3. PubMed DOI

Stawicki S. P. and Gerlach A. T., “Polypharmacy and Medication Errors: Stop, Listen, Look, and Analyze,” Opus 12 (2009): 6–10.

Topinková E., Fialová D., and Matějovská Kubešová H., “Potentially Unsuitable (Risk) Therapy in the Elderly: Expert Consensus for the Czech Republic 2012,” Praktický lékař 1 (2012): 11–22 (in Czech).

Gurwitz J. H., Field T. S., Avorn J., et al., “Incidence and Preventability of Adverse Drug Events in Nursing Homes,” American Journal of Medicine 109, no. 2 (2000): 87–94, 10.1016/s0002-9343(00)00451-4. PubMed DOI

Topinková E. and Ficková D., “Effective and Safe Pharmacotherapy in Old Age,” Postgraduální Medicína 5 (2002): 477–482.

Lindley C. M., Tully M. P., Paramsothy V., and Tallis R. C., “Inappropriate Medication Is a Major Cause of Adverse Drug Reactions in Elderly Patients,” Age and Ageing 21, no. 4 (1992): 294–300, 10.1093/ageing/21.4.294. PubMed DOI

Beers M. H., Ouslander J. G., Rollingher I., Reuben D. B., Brooks J., and Beck J. C., “Explicit Criteria for Determining Inappropriate Medication Use in Nursing Home Residents,” Archives of Internal Medicine 151, no. 9 (1991): 1825–1832, 10.1001/archinte.1991.00400090107019. PubMed DOI

O'Mahony D., “STOPP/START Criteria for Potentially Inappropriate Medications/Potential Prescribing Omissions in Older People: Origin and Progress,” Expert Review of Clinical Pharmacology 13, no. 1 (2020): 15–22, 10.1080/17512433.2020.1697676. PubMed DOI

Kalafutová S., Šulcová H., Jurašková B., and Vlček J., “Pharmacotherapy of the Elderly in Retirement Homes,” Geriatrie a Gerontologie 3 (2014): 65–70.

Halli‐Tierney A. D., Scarbrough C., and Carroll D., “Polypharmacy: Evaluating Risks and Deprescribing,” American Family Physician 100, no. 1 (2019): 32–38. PubMed

Šola K. F., Mucalo I., Brajković A., Jukić I., Verbanac D., and Vladimir Knežević S., “Drug Therapy Problems Identified Among Older Adults Placed in a Nursing Home: The Croatian Experience,” Journal of International Medical Research 48, no. 6 (2020): 0300060520928791, 10.1177/0300060520928791. PubMed DOI PMC

Fog A. F., Kvalvaag G., Engedal K., and Straand J., “Drug‐Related Problems and Changes in Drug Utilization After Medication Reviews in Nursing Homes in Oslo, Norway,” Scandinavian Journal of Primary Health Care 35, no. 4 (2017): 329–335, 10.1080/02813432.2017.1397246. PubMed DOI PMC

Díez R., Cadenas R., Susperregui J., et al., “Drug‐Related Problems and Polypharmacy in Nursing Home Residents: A Cross‐Sectional Study,” International Journal of Environmental Research and Public Health 19, no. 7 (2022): 4313, 10.3390/ijerph19074313. PubMed DOI PMC

Furniss L., Burns A., Craig S. K., Scobie S., Cooke J., and Faragher B., “Effects of a Pharmacist's Medication Review in Nursing Homes: Randomised Controlled Trial,” British Journal of Psychiatry 176, no. 6 (2000): 563–567, 10.1192/bjp.176.6.563. PubMed DOI

Ruths S., Straand J., and Nygaard H. A., “Multidisciplinary Medication Review in Nursing Home Residents: What Are the Most Significant Drug‐Related Problems? The Bergen District Nursing Home (BEDNURS) Study,” BMJ Quality and Safety 12, no. 3 (2003): 176–180, 10.1136/qhc.12.3.176. PubMed DOI PMC

Whitley H. P. and Lindsey W., “Sex‐Based Differences in Drug Activity,” American Family Physician 80, no. 11 (2009): 1254–1258. PubMed

Doherty A. S., Boland F., Moriarty F., Fahey T., and Wallace E., “Adverse Drug Reactions and Associated Patient Characteristics in Older Community‐Dwelling Adults: A 6‐Year Prospective Cohort Study,” British Journal of General Practice 73, no. 728 (2023): e211–e219, 10.3399/BJGP.2022.0181. PubMed DOI PMC

Matsuyama T., Tachi T., Katsuno H., et al., “Effects of Polypharmacy on the Prevalence of Adverse Drug Events Resulting in Outpatient Visits and Hospitalization,” Die Pharmazie – An International Journal of Pharmaceutical Sciences 76, no. 6 (2021): 279–286, 10.1691/ph.2021.1427. PubMed DOI

Gnjidic D., Hilmer S. N., Blyth F. M., et al., “Polypharmacy Cutoff and Outcomes: Five or More Medicines Were Used to Identify Community‐Dwelling Older Men at Risk of Different Adverse Outcomes,” Journal of Clinical Epidemiology 65, no. 9 (2012): 989–995, 10.1016/j.jclinepi.2012.02.018. PubMed DOI

Kwan D. and Farrell B., “Polypharmacy: Optimizing Medication Use in Elderly Patients,” Practice 20 (2013): 25.

Fog A. F., Mdala I., Engedal K., and Straand J., “Variation Between Nursing Homes in Drug Use and in Drug‐Related Problems,” BMC Geriatrics 20, no. 1 (2020): 1–9. PubMed PMC

Pretorius R. W., Gataric G., Swedlund S. K., and Miller J. R., “Reducing the Risk of Adverse Drug Events in Older Adults,” American Family Physician 87, no. 5 (2013): 331–336. PubMed

Alvim M. M., da Cruz D. T., Aquino G. d. A., and Leite I. C. G., “Study on Medication Prescription in the Elderly Population: Benzodiazepine Use and Potential Drug Interactions,” Cadernos Saúde Coletiva 29, no. 2 (2021): 209–217, 10.1590/1414-462x202129020480. DOI

Lukačišinová A., Fialová D., Peel N. M., et al., “The Prevalence and Prescribing Patterns of Benzodiazepines and Z‐Drugs in Older Nursing Home Residents in Different European Countries and Israel: Retrospective Results From the EU SHELTER Study,” BMC Geriatrics 21 (2021): 277. PubMed PMC

Glass J., Lanctôt K. L., Herrmann N., Sproule B. A., and Busto U. E., “Sedative Hypnotics in Older People With Insomnia: Meta‐Analysis of Risks and Benefits,” BMJ 331, no. 7526 (2005): 1169, 10.1136/bmj.38623.768588.47. PubMed DOI PMC

Maust D. T., Kales H. C., Wiechers I. R., Blow F. C., and Olfson M., “No End in Sight: Benzodiazepine Use in Older Adults in the United States,” Journal of the American Geriatrics Society 64, no. 12 (2016): 2546–2553, 10.1111/jgs.14379. PubMed DOI PMC

Lehti T. E., Rinkinen M. O., Aalto U., et al., “Prevalence of Musculoskeletal Pain and Analgesic Treatment Among Community‐Dwelling Older Adults: Changes From 1999 to 2019,” Drugs & Aging 38, no. 10 (2021): 931–937, 10.1007/s40266-021-00888-w. PubMed DOI PMC

Vandraas K. F., Spigset O., Mahic M., and Slørdal L., “Non‐Steroidal Anti‐Inflammatory Drugs: Use and Co‐Treatment With Potentially Interacting Medications in the Elderly,” European Journal of Clinical Pharmacology 66, no. 8 (2010): 823–829, 10.1007/s00228-010-0825-2. PubMed DOI

American Geriatrics Society Beers Criteria® Update Expert Panel , “American Geriatrics Society 2023 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults,” Journal of the American Geriatrics Society 71, no. 7 (2023): 2052–2081, 10.1111/jgs.18372. PubMed DOI

Algabbani A. M. and Alangari A. S., “Proton Pump Inhibitor Prescribing Patterns and Utilization: A Retrospective Chart Review Analysis,” Saudi Pharmaceutical Journal 31, no. 12 (2023): 101841, 10.1016/j.jsps.2023.101841. PubMed DOI PMC

Rane P. P., Guha S., Chatterjee S., and Aparasu R. R., “Prevalence and Predictors of Non‐Evidence Based Proton Pump Inhibitor Use Among Elderly Nursing Home Residents in the US,” Research in Social and Administrative Pharmacy 13, no. 2 (2017): 358–363, 10.1016/j.sapharm.2016.02.012. PubMed DOI

Maes M. L., Fixen D. R., and Linnebur S. A., “Adverse Effects of Proton‐Pump Inhibitor Use in Older Adults: A Review of the Evidence,” Therapeutic Advances in Drug Safety 8, no. 9 (2017): 273–297, 10.1177/2042098617715381. PubMed DOI PMC

Díez R., Cadenas R., Susperregui J., et al., “Potentially Inappropriate Medication and Polypharmacy in Nursing Home Residents: A Cross‐Sectional Study,” Journal of Clinical Medicine 11, no. 13 (2022): 3808, 10.3390/jcm11133808. PubMed DOI PMC

Zito S., Poluzzi E., Pierantozzi A., et al., “Medication Use in Italian Nursing Homes: Preliminary Results From the National Monitoring System,” Frontiers in Pharmacology 14 (2023): 1128605, 10.3389/fphar.2023.1128605. PubMed DOI PMC

AlMutairi H., O'Dwyer M., McCarron M., McCallion P., and Henman M. C., “The Use of Proton Pump Inhibitors Among Older Adults With Intellectual Disability: A Cross Sectional Observational Study,” Saudi Pharmaceutical Journal 26, no. 7 (2018): 1012–1021, 10.1016/j.jsps.2018.05.009. PubMed DOI PMC

American Geriatrics Society Beers Criteria Update Expert Panel , “American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults,” Journal of the American Geriatrics Society 63, no. 11 (2015): 2227–2246. PubMed

Milton J. C., Hill‐Smith I., and Jackson S. H. D., “Prescribing for Older People,” BMJ 336, no. 7644 (2008): 606–609, 10.1136/bmj.39503.424653.80. PubMed DOI PMC

Wu J. Y. F., Leung W. Y., Chang S., et al., “Effectiveness of Telephone Counselling by a Pharmacist in Reducing Mortality in Patients Receiving Polypharmacy: Randomised Controlled Trial,” BMJ 333, no. 7567 (2006): 522, 10.1136/bmj.38905.447118.2F. PubMed DOI PMC

Cortejoso L., Dietz R. A., Hofmann G., Gosch M., and Sattler A., “Impact of Pharmacist Interventions in Older Patients: A Prospective Study in a Tertiary Hospital in Germany,” Clinical Interventions in Aging 11 (2016): 1343–1350, 10.2147/CIA.S109048. PubMed DOI PMC

Viana S. d. S. C., Arantes T., and Ribeiro S. C. d. C., “Interventions of the Clinical Pharmacist in an Intermediate Care Unit for Elderly Patients,” Einstein (São Paulo) 15, no. 3 (2017): 283–288, 10.1590/s1679-45082017ao3894. PubMed DOI PMC

Lee S. W. H., Mak V. S. L., and Tang Y. W., “Pharmacist Services in Nursing Homes: A Systematic Review and Meta‐Analysis,” British Journal of Clinical Pharmacology 85, no. 12 (2019): 2668–2688, 10.1111/bcp.14101. PubMed DOI PMC

The Society of Hospital Pharmacists of Australia , “Geriatric Medicine and Aged Care Clinical Pharmacy Services [Position Statement],” (2021).

Royal Pharmaceutical Society England , “SHAPING PHARMACY FOR THE FUTURE: Pharmacists Improving Medicines Use in Care Homes,” (2016).

Patel S. and Krishnaswami A., “The Role of Pharmacists in the Care of Older Adults With Multiple Chronic Conditions in a Multidisciplinary, Team‐Based Setting,” (2015).