The experience of dissolving polypharmacy by reducing the prescription of anti-ulcer drugs in residents of a special geriatric nursing home.

AIM: As part of a broader study on polypharmacy among elderly nursing home residents, we examined the impact of reducing or discontinuing the prescription of proton pump inhibitors and other anti-ulcer drugs.

METHODS: We employed a strategy of reducing and discontinuing the prescription of drugs to 160 elderly residents of the Hiroshima Atomic Bomb survivors nursing home, Kandayama Yasuragien. The residents had entered the home between April 2012 and November 2015. As part of this study into anti-ulcer drugs, we also measured the concentrations of Helicobacter pylori antigen in stool specimens, and the serum concentrations of H pylori antibodies and pepsinogen I and II.

RESULTS: The proportions of residents who were taking more than six drugs on April 2012, August 2014 and November 2015 were 55.2%, 49.0% and 43.0%, respectively. At the same times, the proportions of residents who were taking anti-ulcer drugs were 50.0%, 49.0% and 6.0%, respectively. The presence of H pylori antigen and antibodies, and serum pepsinogen concentrations, did not influence the decisions to continue or discontinue anti-ulcer drugs.

CONCLUSIONS: We have already reported that reduction of diuretics reduces the incidence of falls and fall-related fractures in our residents, and have demonstrated the benefits of discontinuing folic acid and drugs that are given to control hyperkalemia. In the present study, we found that many anti-ulcer drugs were also of low necessity to elderly care home residents. It is essential to examine the clinical benefits of addressing polypharmacy in elderly individuals. In the future, we intend to focus on reducing hypnotics, laxatives and other drugs.