Drug use and polypharmacy incidence in community state-run older adult care homes in Malta

Abstract

Aims & objectives: The aim and objectives of this research project was to refute or accept the initial hypothesis of excessive polypharmacy drug use and pharmaceutical drug use amongst older adults living in the four community-state-run residential care homes. The study also aspired to investigate the extent of drug-to-drug interactions/adverse effects amongst these individuals, as well as to forward a number of recommendations based on findings and suggest plausible ways for overcoming such practices. Background: As the world continues to evolve, and people grow older, older adults are renowned to suffer from multimorbid medical conditions. Whilst the abundant world and medical industry has well been ingrained in today’s life, including the use and admittance to long-term care institution and use of pharmaceutical drug prescriptions as the first line care of practices, residential care homes are often thought to favor pharmaceutical drug prescriptions driven by the paternalistic biomedical framework, other from using for instance complementary and alternative medications (CAMs). Method: Following a literature review both on the subject as well as quantitative research methods, the study recruited a total of 196 participants through a randomized convenience sampling techniques, 5 of which passed away during the course of the study and thus were eliminated due to the inaccessibility of data. The use of gatekeepers in the four community-state-run residential care homes (the head of homes), as well as pre-made ‘EXCEL’ sheets, were utilized to gather data. Results were later generated by the use of both ‘EXCEL’ and ‘SPSS’ programs and tests such as ‘Spearman’s’, the ‘Kruskal-Wallis test’ and ‘t-test’ were utilized accordingly. Results: As initially hypothesized in this research project, this study has found the great majority of participants as having polypharmacy practices. Whilst the recruited participants had significant debility, necessitating treatment, the study has found little to no differences between gender effects in regard to pharmaceutical drug use and polypharmacy practices. However, residing in long-term care was common in individuals with moderate mobility that was established by the Barthel scoring, and in terms of longevity enrolled participants were generally not in a state of well-being when considering the mean number of comorbidities and level of functional deterioration found. Drug-to-drug interactions, as well as the use of the STOP/START criteria and online ‘EPOCRATES’ drug checker, were found useful tools in determining the extent of drug-to-drug interactions and plausible encountered side-effects in enrolled participants. Conclusion: The study concluded that a multidisciplinary team approach and the use of CAMs as a supplement to the traditional biomedical paternalistic framework is needed when the STOP/START criteria and online EPOCRATES web checker were utilized. Furthermore, moving toward a person-centered approach to eradicating a single-centered disease approach is needed.