Abstract
Care home residents represent a frail population with limited life expectancy and are often prescribed multiple medications. As therapeutic goals shift in this population, certain treatments may become inappropriate. This study aims to describe potentially inappropriate medication use among Danish care home residents using the Screening Tool of Older Persons Prescriptions in Frail adults with limited life expectancy (STOPPFrail) in a nationwide cohort of all Danish care home residents admitted 2015-2023, focusing on the time around admission and the last year of life. The cohort comprised 129 635 residents (61% women, median age 84 years). Around admission, 88% used at least one STOPPFrail medication, most commonly antihypertensives (58% before, 55% after), lipid-lowering therapies (31%, 27%) and proton-pump inhibitors (30%, 30%). The rate of new use increased from 2.6/100 residents/month 2 years before admission, peaking at 9.6/100 residents/month 2 months prior. Hospital physician prescribing increased as care home admission approached, after which general practitioners prescribed most prescriptions. Over 90% used at least one STOPPFrail medication during the last year of life, with increases in proton-pump inhibitors and antipsychotics, the latter most frequently initiated in the last 4 months. These findings underscore the importance of regular assessment and targeted efforts to improve prescribing appropriateness.