Pros, Cons to Multiple Meds for Nursing Home Residents
TUESDAY, April 9, 2019 (HealthDay News) -- There's an upside and a downside to prescribing nursing home residents a long list of medicines, new research confirms.
Taking multiple meds can boost a resident's odds of survival after a heart attack, for example, but it may also lower their ability to safely perform daily activities, researchers reported April 9 in the journal Circulation: Cardiovascular Quality and Outcomes.
So, medication plans often hinge on decisions about the quantity of a patient's life versus its quality, the researchers said.
"Using more medications to prevent another heart attack may be useful for vulnerable older adults who wish to live longer," study author Andrew Zullo said in a journal news release.
"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," he added.
Zullo is assistant professor of health services, policy, and practice at Brown University in Providence, R.I.
One cardiologist who often deals with older, frail patients agreed that the use of multiple meds can be tricky.
"Nursing home patients are some of the most fragile patients," said Dr. Satjit Bhusri, who practices at Lenox Hill Hospital in New York City.
"It is a fine line between providing lifesaving and necessary medication and frailty," Bhusri said. "It is also a conversation that is very patient-specific: I always discuss with my frail patients quality of life. This is the most important factor in deciding what medications are appropriate and what medications, although indicated, can worsen their quality of life."
In the Brown University study, Zullo's team focused on the use in nursing homes of prescription medications such as statins, beta blockers, blood thinners and other blood pressure drugs. All work to prevent new and repeat heart attacks by controlling high blood pressure and high cholesterol.
The researchers analyzed data on more than 4,700 U.S. nursing home residents, average age 84, who had survived a heart attack.
There was a survival benefit to multiple medication use. People who were prescribed three or four medications were 26 percent less likely to die within 90 days after leaving the hospital than those prescribed one medication, Zullo and colleagues found.
But the benefit seemed limited to three pills and up: People who received two medications did not have any lower odds for death than those who received one.
On the other hand, there was a real downside to taking three or four meds per day. That's because people on multiple-med regimens typically had more trouble managing their daily activities, the research showed.
Dr. Benjamin Hirsh directs preventive cardiology at Northwell Health's Sandra Atlas Bass Heart Hospital in Manhasset, N.Y. Looking over the new findings, he agreed that decisions on multiple medication use are best made on a patient-by-patient basis.
Hirsh pointed out that the study couldn't prove that taking three or more medicines was a direct cause of lowered daily function.
However, "quality of life and patient preference is paramount at this age and functional status," Hirsh said, so "physicians must understand the wishes of the patient and family and discuss individual goals and expectations of therapy."
In turn, this "fosters trust and a personalized approach to achieve the patient's wishes," he said.
The American Heart Association has more on heart attack recovery.
SOURCES: Satjit Bhusri, M.D., cardiologist, Lenox Hill Hospital, New York City; Benjamin J. Hirsh, M.D., director, preventive cardiology, Northwell Health's Sandra Atlas Bass Heart Hospital, Manhasset, N.Y.; Circulation: Cardiovascular Quality and Outcomes, news release, April 9, 2019