The average number of medications taken per resident decreased by 8 percent.
NEW YORK, NY—October 9, 2024— A UHF partnership with nursing homes focused on safe “deprescribing”—decreasing the use of potentially inappropriate medications—has successfully reduced the average number of medications prescribed to each resident for the second year, according to a report released today. The report, Reducing the Risk: Year 2 Report of the Polypharmacy in Nursing Homes Learning Collaborative, found that seven participating nursing homes reduced the average number of medications per resident by 8 percent, and decreased the percentage of residents on 10 or more medications.
Polypharmacy, also known as medication overload, refers to the prescribing of an inappropriately high number of medications and has become increasingly recognized as a health risk to older adults. It is known to increase the likelihood of adverse events, and the risk of drug-drug interactions and side effects has been shown to grow as the number of medications an individual takes increases. In fact, an estimated 50 percent of nursing home residents receive nine or more medications, and their rate of adverse drug reactions is twice as high as that of residents taking fewer than nine. Recognizing this growing problem, UHF’s Quality Institute first launched The Polypharmacy in Nursing Homes Learning Collaborative in 2022.
“With another year of promising success, our polypharmacy initiative has shown that systematically addressing medication overload in nursing homes can result in a marked decrease in the use of high-risk medications and can improve residents’ quality of life,” said Joan Guzik, director of quality and efficiency at UHF’s Quality Institute and one of the authors of the report. “By taking a patient-centered approach and involving a multidisciplinary team, nursing homes can tackle deprescribing in a way that improves safety, benefiting residents, their families, and facility staff.”
A focus of the polypharmacy collaborative’s second year was introducing participating nursing homes to the Age-Friendly Health Systems (AFHS) framework, which uses evidence-based interventions and a person-centered approach to improve the care of older adults. The framework centers around the “4Ms” of care: what matters, medication, mentation, and mobility—ensuring that the input and preferences of the patient are in mind when addressing a medication regimen.
In line with this new framework, the collaborative expanded the list of medications targeted for deprescribing in year two. Nursing homes chose two or three medications from a list of 12 to target in their interventions. The medications included proton pump inhibitors for acid reflux, the world’s most prescribed drug; antihypertensives for high blood pressure; benzodiazepines, a class of drug for anxiety; opioids, muscle relaxers, antihistamines, and mood stabilizers, among others. Across the seven facilities, the use of all but one of the targeted medications was reduced during the interventions. Most medications saw significant reductions, including antihistamines (68%), antidepressants (62%), and opioids (53%).
The seven participants in year two were Eger Health Care and Rehabilitation Center, Gurwin Jewish Nursing and Rehabilitation Center, Hebrew Home at Riverdale, Jamaica Hospital Nursing Home, Mary Manning Walsh Nursing Home, The New Jewish Home, and Manhattan NYC Health + Hospitals/Gouverneur.
In addition to its results, the year-2 report includes recommendations and tools for other long-term care facilities interested in starting a deprescribing project. Plus, participating facilities shared anecdotes of the collaborative’s impact on residents, caregivers, and nursing home staff. Among these positive changes: residents were reported to be more attentive, more comfortable, less agitated, and to have improved comprehension and a better appetite.
“This report is another significant step toward increasing awareness about the issue of polypharmacy, which exists across the continuum of care,” said Oxiris Barbot, MD, president and CEO of United Hospital Fund. “Educating patients, families, and health care providers on this important medical practice issue can better ensure that the long-term risks of polypharmacy in older adults are minimized. We hope that other nursing homes will utilize the resources, tools, and examples provided in this report to implement deprescribing interventions in their facilities.”
The polypharmacy initiative to reduce medication overload is supported by the Mother Cabrini Health Foundation and TD Charitable Foundation. In addition to Ms. Guzik, the report was written by Alice Ehrlich, senior program manager, Quality Institute, and Kevin Mallon, MSW, program manager, Quality Institute.
The report can be downloaded free of charge from UHF’s website here.
About United Hospital Fund
United Hospital Fund works to build an effective and equitable health care system for every New Yorker. An independent, nonprofit organization, we are a force for improvement, analyzing public policy to inform decision-makers, finding common ground among diverse stakeholders, and developing and supporting innovative programs that improve health and health care. We work to dismantle barriers in health policy and health care delivery that prevent equitable opportunities for health. For more on our initiatives and programs please visit our website at www.uhfnyc.org and follow us on LinkedIn, X., Instagram, and Facebook.
About The Mother Cabrini Health Foundation
The Mother Cabrini Health Foundation is a private, nonprofit organization whose mission is to improve the health and wellbeing of New Yorkers, bolster the health outcomes of vulnerable communities, eliminate barriers to care, and bridge gaps in health services. Named after a tireless advocate for immigrants, children, and the poor, the Mother Cabrini Health Foundation funds programs and initiatives across New York State that either provide direct healthcare services or address the social determinants of health. For more information, visit https://www.cabrinihealth.org/
About The TD Charitable Foundation
The TD Charitable Foundation is the charitable giving arm of TD Bank, America’s Most Convenient Bank®, one of the 10 largest banks in the U.S., providing over 9.8 million customers with a full range of retail, small business, and commercial banking products and services at more than 1,100 convenient locations throughout the Northeast, Mid-Atlantic, Metro D.C., the Carolinas, and Florida. Since its inception in 2002, the Foundation has distributed over $323 million through donations to local nonprofits from Maine to Florida. More information on the TD Charitable Foundation is available at www.tdbank.com/corporate-responsibility/the-ready-commitment/funding-opportunities