Prevalence of inappropriate medication use in residential long-term care facilities for the elderly: A systematic review

Background: Multi-morbidity and polypharmacy of the elderly population enhances the probability of elderly in residential long-term care facilities experiencing inappropriate medication use. Objectives: The aim is to systematically review literature to assess the prevalence of inappropriate medication use in residential long-term care facilities for the elderly. Methods: Databases (MEDLINE, EMBASE) were searched for literature from 2004 to 2016 to identify studies examining inappropriate medication use in residential long-term care facilities for the elderly. Studies were eligible when relying on Beers criteria, STOPP, START, PRISCUS list, ACOVE, BEDNURS or MAI instruments. Inappropriate medication use was defined by the criteria of these seven instruments. Results: Twenty-one studies met inclusion criteria. Seventeen studies relied on a version of Beers criteria with prevalence ranging between 18.5% and 82.6% (median 46.5%) residents experiencing inappropriate medication use. A smaller range, from 21.3% to 63.0% (median 35.1%), was reported when considering solely the 10 studies that used Beers criteria updated in 2003. Prevalence varied from 23.7% to 79.8% (median 61.1%) in seven studies relying on STOPP. START and ACOVE were relied on in respectively four (prevalence: 30.5-74.0%) and two studies (prevalence: 28.9-58.0%); PRISCUS, BEDNURS and MAI were all used in one study each. Conclusions: Beers criteria of 2003 and STOPP were most frequently used to determine inappropriate medication use in residential long-term care facilities. Prevalence of inappropriate medication use strongly varied, despite similarities in research design and assessment with identical instrument(s).