Gerontology & Geriatric Research

Abstract

Treatment of Hypertension in Frail Older Adults in Nursing Homes:Evaluation of an Educational Intervention for Physicians

Jill Duncan, Paige Moorhouse, Laurie Mallery and Susan K Bowles

Background: New treatment recommendations for hypertension, specific to the frail elderly, have recently been published. We aimed to determine the effect of an educational intervention on appropriateness of prescribing for hypertension in a nursing home setting using an observational, before and after study design in a single nursing home, as measured by adherence to each of the four key messages of the treatment recommendations. Results: 138 nursing home residents participated in the study. A total of 17% of residents had a systolic blood pressure ≥140mm Hg and only 4% had SBP ≥150 mm Hg. The percentage of residents taking one or more medication affecting blood pressure decreased from 60.2% prior to the intervention to 51.9% in the post-intervention population (p=0.003) The proportion of residents prescribed 2 or more medications affecting blood pressure decreased from 36.4% pre-intervention to 23.1% post intervention (p=0.002). Median monthly cost for medications affecting blood pressure was $4.18 pre-intervention and decreased to $1.05 post-intervention (p<0.001). Conclusion: Nursing home residents may be over-treated for hypertension. A multi-faceted educational intervention can decrease the use of medications affecting blood pressure in a frail population.