Drug-Nutrient Interactions in Three Long-Term-Care Facilities

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Abstract

Objective To assess the risk of drug-nutrient interactions (DNIs) in three long-term-care facilities.

Design Retrospective audit of charts.

Setting Three long-term-care facilities in central New York State.

Subjects Fifty-three patients selected randomly from each facility.

Measurement Data were collected from the medical record of each patient for a period of 6 months. A computerized algorithm was used to assess the risk for DNIs. Mean drug use, most frequently consumed drugs, incidence of potential DNIs, and the most commonly observed potential DNIs are reported.

Results In facilities A, B, and C, respectively, patients consumed a mean of 4.86, 4.04, and 5.27 drugs per patient per month and were at risk for a mean of 1.43, 2.69, and 1.43 potential DNIs per patient per month. The most commonly observed potential DNIs were gastrointestinal interactions affecting drug bioavailability and interactions affecting electrolyte status.

Conclusions Patients in long-term-care facilities, who are primarily elderly and chronically ill and who consume multiple medications, are at notable risk for certain DNIs. Efforts need to be made to ensure appropriate pharmacologic and nutrition therapies as well as adequate and timely monitoring of patients in these facilities. Dietitians can play an important role in training other health professionals and in designing policies to prevent DNIs. J Am Diet Assoc. 1995; 95:309-315.

Section snippets

Subjects

Patients were from three long-term-care facilities that provide skilled and intermediate levels of care. The study design was approved by the administrative boards of each of the facilities and by the Human Subjects Review Committee at Cornell University.

Fifty-three patients were selected from each facility. Patients with a terminal condition and those admitted for less than 6 months before the onset of the study were not chosen. All patients from the skilled nursing units of facilities A and B

Sample Characteristics

A total of 158 subjects (53 each from facility A and facility C and 52 from facility B) were included in the research. Sex and age characteristics of the study population are summarized in Table 1. Of the three facilities, facility B had the oldest population and the fewest men in the sample. Most of the patients suffered from multiple chronic conditions. Table 2 lists the most frequently reported diagnoses at the onset of the study. Coronary artery disease was the most common diagnosis in all

Discussion

The patients in this study had, in general, characteristics similar to those reported in other surveys of nursing home patients in terms of age, ratio of men to women, most prevalent medical conditions, and number and kinds of medications consumed (12), (14), (20), (21), (22), (23). Although data have been reported on the incidence of adverse drug reactions among various groups (24), (25), (26), (27), (28), (29), (30), (31), (32), including the elderly, our research represents an innovative

Applications

The final goal of our research is to identify strategies for intervention and prevention of DNIs. Potentially, these strategies could take three forms: educational, administrative, and monitoring.

Education of health care providers about different kinds of DNIs and ways to prevent them is key. Educational intervention should focus particular attention on the prevention of GI interactions and interactions that affect electrolyte balance, because these appear to be prevalent among patients in

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