Impact of Inappropriate Medication Spending on Nursing Home Residents’ Emergency Care Visit Risk

"Dementia is now a public health priority in most countries. Use of prescription drugs and hospitalization admissions among patients with dementia are very high, and may have detrimental and persistent effects on subjects' health. These issues are particularly important among nursing home residents, who are often over-medicated. This article explores the impact of an exogenous increase in medication spending of people with dementia on emergency room (ER) visits risks. We take advantage of the IDEM Cluster Randomized Clinical Trial (Systematic Dementia Screening by Multidisciplinary Team Meetings in Nursing Homes) to instrument medication spending (Fstat for weak instrument>10). Our results suggest that an increase in medication spending is strongly associated with increased ER visit risks. Besides, the strength of the association increases with the proportion of inappropriate drugs spending among total medications spending. Our findings underline the need to better monitor the use of medication in nursing homes and to improve care integration between nursing homes and hospitals. Our findings also advocate for an increase in social care provision in nursing homes, as a complement or substitute to pharmaceutical treatment."