decades. In
the late 1990's, the US Center of Medicare and Medicaid Services felt this to be such an
important issue that it implemented a quality indicator measure targeting patients on 9 or
more medications. A study using data from the 2004 United States Nursing Home Survey found that 39.7% had polypharmacy defined by this quality indicator measure [8]. Of note
the group with the lowest rate of polypharmacy was those patients age 85 years or older
(34.8%). Table 1 shows the top ten most common medication classes used among this
nursing home population. In contrast, a study of 64,395 Canadian nursing home patients
studied reported that only 15.5% were on > 9 medications [9]. The top therapeutic drug
classes prescribed to this cohort can be seen in Table 1. To the best of our knowledge no
multisite study has been conducted examining unnecessary drug use in older nursing home
patients [2].
Nursing Home Setting