Reducing polypharmacy in the nursing home: an activist approach.

BACKGROUND Nursing home patients generally take many medications and are at risk for drug side effects and interactions. These patients are often frail, have multiple medical problems, and many have severe cognitive deficits. METHODS Recommendations for reducing polypharmacy in nursing home patients were formulated based upon a review of the medical literature. In many cases, studies of nursing home patients have not been done, and data are extrapolated from other populations. RESULTS AND CONCLUSIONS The family physician should actively attempt to reduce the nursing home patient's drug list to those drugs that are most likely to improve or maintain function. Anticonvulsants and antiarrhythmics often can be withdrawn, and medications for angina and hypertension might be simplified. Drugs used solely for prevention, such as lipid-lowering agents or anticoagulants, might not have a favorable impact on patients with limited life expectancies. Careful review of the medication list could prevent iatrogenic complications and maximize function in nursing home patients.