Polypharmacy and Drug-Drug Interactions in Long-Term Care Facilities residents: findings from the Italian Prescription Day Project

BACKGROUND: Medication prescribing in Long-Term Care Facilities (LTCFs) is characterised by widespread polypharmacy and frequent exposure to potentially clinically relevant drug-drug interactions (DDIs). METHODS: Data from the Italian Prescription Day in LTCFs 2024, a national multicentre point-prevalence study conducted in 82 LTCFs, were analysed. Prescriptions were classified using the Anatomical Therapeutic Chemical system, and DDIs were identified using an international consensus list. Resident-level variables were assessed using validated tools, and associations with DDI burden were examined using univariate mixed-effects Poisson regression models. Facility-level organisational characteristics were described by centre-level DDI burden. RESULTS: The analysis included 3,174 residents (mean age 84.8 years; 74.1% women), with a mean of 7.7 prescribed drugs. Drugs acting on the nervous system, alimentary tract and metabolism, and cardiovascular system were most frequently prescribed; furosemide, paracetamol, pantoprazole, quetiapine, and macrogol were the most commonly used active substances. Overall, 42.2% of residents were exposed to at least one potentially clinically relevant DDI, most commonly involving centrally acting drugs, cumulative anticholinergic burden, serotonergic combinations, and potassium-related interactions. Higher DDI burden was associated with greater pharmacological complexity, depression, sleep disorders, cardiopulmonary disease, and behavioural and psychological symptoms of dementia, whereas older age, severe cognitive impairment, malnutrition, and dysphagia were associated with fewer DDIs. Facility-level and staffing characteristics showed limited differentiation, with assisted living facilities under-represented at higher DDI burden. CONCLUSIONS: Potentially clinically relevant DDIs are common in Italian LTCFs and are primarily associated with resident-level clinical complexity, highlighting targets for medication review and deprescribing to improve medication safety.

Authors

Institutions

Publication Details

Journal
The Journals of Gerontology Series A
Published
2026-04-15
DOI
https://doi.org/10.1093/gerona/glag104
Primary Topic
Pharmaceutical Practices and Patient Outcomes
Type
article
Field-Weighted Citation Impact
0.00
Controls
|||
ALL TIME
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
article

Polypharmacy and Drug-Drug Interactions in Long-Term Care Facilities residents: findings from the Italian Prescription Day Project

Ivonne Capelli, Chiara Cutaia, N. Cattaneo, L.S. Bogdan et al.
The Journals of Gerontology Series A
Pharmaceutical Practices and Patient Outcomes
article

Polypharmacy and Drug-Drug Interactions in Long-Term Care Facilities residents: findings from the Italian Prescription Day Project

Ivonne Capelli, Chiara Cutaia, N. Cattaneo, L.S. Bogdan, Angela Belsito, Roberto De Gesu, Chiara Filippini, Anna Castaldo, Sara Albertini, Alberto Zucchelli, Ludovica Aliberti, Elena Ferrighi, Saverio Celletti, Andrea Fabbo, Carmine Cafariello, Stefano Cassano, Leonardo Ascatigno, Federica Davolio, Caterina Trevisan, Dario Leosco, Alessandra Marengoni, Angela Marie Abbatecola, Daniele Elmi, Francesca Fortunato, Giuseppe Dario Testa, Francesca Arenare, Alba Malara, Bianca Faraci, Gilda Borselli, Michela Compiano, Nicola Galdiero, Ilaria Bandera, C. De Sanctis, Carla Capasso, Federica Coscetta, Giuseppe D’Ambrosio, Martina D’Arienzo, Silvia Crucito, Andrea Berti, Eleanor De Gennaro, Alessandra Federico, Davide Anzà, Laura Argentero, Annalisa Berti, Arianna Debora Bertucci, Raffaella Frongillo, Maria Burdino, Chiara Celentano, Fladona Beqiri, Antonio Cherubini, Paola Covili, Yvan Thierry Dama, Sara Maria Colombo, Giuseppe Battaglia, Annalisa Ballati, Giuseppe Bonanno, Siro Candiano, Mattia Di Poto, Tommasina Di Brango, Giuseppe Cecchi, Valentina Cuzzolin, Graziano Onder, Francesco Baldini, Teresa Donadio, Nadia Cavaliere Felcino, Florida Driza, Angelica Maria Chiesara, Prescription Day LTCFs Workgroup, Raffaele Antonelli Incalzi, Federica Cesaro, Alessia Cavallaro, Giusy Bruzzese, Giulia Maria Antonietti, Andrea Ungar, Michela Faraglia, Maria Grazia Corrado, Giovanni De Filippo, Gianluca Calogero, Luisa Curti, Herman Bacoli, Madalina Curea, Luciano Cristarella, Romina Cedrone, Rosa Filippelli, Nicolò Fanti, Antonio Antoniadis, Basilio Battisti, Mario Cucumo, Erica Covi, Enrica Castelbano, Alice Fuser, Ioana Avasilcai, Antonio De Simone, Francesca Abramo, Alessandro Morandi, Concetta Bevilacqua
article en

Abstract

BACKGROUND: Medication prescribing in Long-Term Care Facilities (LTCFs) is characterised by widespread polypharmacy and frequent exposure to potentially clinically relevant drug-drug interactions (DDIs). METHODS: Data from the Italian Prescription Day in LTCFs 2024, a national multicentre point-prevalence study conducted in 82 LTCFs, were analysed. Prescriptions were classified using the Anatomical Therapeutic Chemical system, and DDIs were identified using an international consensus list. Resident-level variables were assessed using validated tools, and associations with DDI burden were examined using univariate mixed-effects Poisson regression models. Facility-level organisational characteristics were described by centre-level DDI burden. RESULTS: The analysis included 3,174 residents (mean age 84.8 years; 74.1% women), with a mean of 7.7 prescribed drugs. Drugs acting on the nervous system, alimentary tract and metabolism, and cardiovascular system were most frequently prescribed; furosemide, paracetamol, pantoprazole, quetiapine, and macrogol were the most commonly used active substances. Overall, 42.2% of residents were exposed to at least one potentially clinically relevant DDI, most commonly involving centrally acting drugs, cumulative anticholinergic burden, serotonergic combinations, and potassium-related interactions. Higher DDI burden was associated with greater pharmacological complexity, depression, sleep disorders, cardiopulmonary disease, and behavioural and psychological symptoms of dementia, whereas older age, severe cognitive impairment, malnutrition, and dysphagia were associated with fewer DDIs. Facility-level and staffing characteristics showed limited differentiation, with assisted living facilities under-represented at higher DDI burden. CONCLUSIONS: Potentially clinically relevant DDIs are common in Italian LTCFs and are primarily associated with resident-level clinical complexity, highlighting targets for medication review and deprescribing to improve medication safety.

The Journals of Gerontology Series A
Università Cattolica del Sacro Cuore (IT), Marche Polytechnic University (IT), Università Campus Bio-Medico (IT), University of Ferrara (IT), Fondazione Roma (IT), Agostino Gemelli University Polyclinic (IT), Karolinska Institutet (SE), Società Italiana di Cardiologia (IT), Istituto Ortopedico Gaetano Pini (IT), Istituto Nazionale di Riposo e Cura per Anziani (IT), Istituti Ospitalieri di Cremona (IT), University of Florence (IT), University of Naples Federico II (IT), University of Brescia (IT)
Good health and well-being
Openalex Percentile: Top 19%
Pharmaceutical Practices and Patient Outcomes
DOISourceOpenAlex
AI Navigator

Ask Laika to Summarize, Analyze, and Connect papers live on the map.

Summarize Papers & Methodologies

Extract key findings, datasets, and comparative methods across publications.

Benchmark Rankings & Visual Analytics

Rank top research institutions, authors, funders, topics, and journals by Field-Weighted Citation Impact (FWCI) and paper volume with instant charts.

Connect Distant Disciplines

Bridge topological clusters on the map to find hidden collaborative intersections.