The need for a more rational approach to drug prescribing for elderly people in nursing homes

In order to establish the pattern of drug use in Irish nursing homes and to compare prescribing rates with those in other countries, drugs prescribed during a 1-week period for 301 residents in 11 nursing homes were recorded. A mean of four drugs (range 0-14) was prescribed per patient and 41% of patients were taking five drugs or more. Forty-two per cent of patients were prescribed potentially interacting combinations and in particular the use of drugs with additive sedative or anticholinergic effects was common. The mean number of drugs prescribed ranged from 2.3 to 5.6 in the different nursing homes, the most notable differences being in the use of digoxin, vitamins, hypnotics and psychotropic drugs. Prescribing rates were similar to those reported from the United Kingdom but very different from data for the United States where prescribing rates for laxatives, neuroleptics and analgesics are higher. Marked variation in prescribing both between institutions and between countries as well as the quantity and pattern of prescribing led to the conclusion that prescribing is less than optimal in this clinical setting. However, additional studies linking diagnosis and prescribing are required to test this hypothesis.