Research paper Centrally active prescribing for nursing home residents - how are we doing? L.D. Hughes a, * ,b,c , J. Hanslip b , M.D. Witham c a University of Dundee Medical School, Dundee, United Kingdom b NHS Education for Scotland, Edinburgh, Scotland c University of Dundee, Dundee, United Kingdom 1. Research in context Older patients are more likely to be prescribed multiple drugs than other age groups as multimorbidity is the norm [1,2]. In addition, older patients are at a greater risk of adverse drug reactions (ADRs) in line with age-related reductions in hepatic metabolism and renal function and can often be more sensitive to the effects of medications than other age groups [3,4]. Older people are commonly prescribed medications with psychoactive properties [2]. Indeed, Guthrie et al. showed that patients with dementia in Tayside (Scotland) have a 17% chance of being prescribed one or more centrally active medications (including antipsychotics, antidepressants and hypnotic/anxioly- tics) [5]. It is important to stress that the high levels of centrally active drug prescription are despite the well-documented health risks associated with these drugs, including an increased risk of worsening cardiovascular and cerebrovascular disease as well as cognitive decline [6,7]. Indeed, a Government funded review by Prof. Sube Banerjee indicated that there could be up to 1800 avoidable patient deaths annually associated with such medica- tions [8]. This clinical study reviewed all prescribed centrally active medications for residents in a nursing home in Dundee. Subse- quent analysis was carried out to examine whether particular patient criteria are associated with an exposure to centrally acting drugs and to examine the adequacy of analgesia for care home residents. 2. Methods 2.1. Study location and patient background The study was undertaken in a purpose-built Dundee nursing home, in June 2010. The unit is specialized for patients with dementia, admitting patients with a confirmed diagnosis of dementia alongside appropriate social work assessment. Impor- tantly, there are two floors (ground floor [GF] and first floor [FF]) with each floor having different admission criteria and run by a separate nursing and care team. An average patient on GF would have severe cognitive impairment, have the majority or all European Geriatric Medicine 3 (2012) 304–307 A R T I C L E I N F O Article history: Received 12 March 2012 Accepted 30 April 2012 Available online 3 August 2012 Keywords: Community geriatrics Pain management Primary care Prescribing A B S T R A C T Introduction: Older patients in nursing homes are more likely to be prescribed multiple drugs than other age groups as multimorbidity is the norm. This clinical study reviewed all prescribed centrally active medications for residents in a nursing home in Dundee. Subsequent analysis was carried out to examine whether particular patient criteria are associated with an exposure to centrally acting drugs and to examine the adequacy of analgesia for care home residents. Methods: The study was carried out in a Dundee nursing home with two different units with varying admission criteria. The research team reviewed patient records establishing background patient characteristics and medical diagnoses where psychoactive prescribing may be appropriate. In addition, information on specific prescribed medications, patient pain scores (PAINAD system), quantified cognition (6CIT score) was gathered. The non-parametric Mann Whitney U test (P < 0.05) was used to compare exposure to CNS active medications between nursing home floors. Results: Patients with dementia in nursing homes are particularly likely to have bodily pain, insomnia and unipolar depression. Patients with more severe dementia were statistically more likely to be exposed to CNS active medications (P-value = 0.01). Importantly, despite being exposed to significant levels of psychoactive prescribing this patient group may be undertreated for chronic pain. Conclusion: Centrally active prescribing in the community for geriatric patients remains high and may be associated with patient risk. Furthermore, despite this patients may be undertreated for pain syndromes. ß 2012 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved. * Corresponding author. E-mail address: lloydforsports99@aol.com (L.D. Hughes). Available online at www.sciencedirect.com 1878-7649/$ – see front matter ß 2012 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved. http://dx.doi.org/10.1016/j.eurger.2012.04.008