***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: INTRODUCTION At present , 7.2 % of the population in Singapore is in the geriatric age group , which will increase to 18.4 % in the year 2030 . The frailest segment of the geriatric population live in nursing homes . They suffer from multiple co-morbidities requiring multiple medication use . Polypharmacy and inappropriate medication use have been considered as quality indicators for nursing home care . As no data of these indicators are available in Singapore , this study was planned to assess the prevalence of polypharmacy and inappropriate medication use in Singapore nursing homes . MATERIAL S AND METHODS A total of 454 residents in the geriatric age group residing in 3 r and omly selected nursing homes were involved in the study . Case notes were review ed for demographic information , clinical history and medication use . The data were analysed for polypharmacy ( 5 or more medication orders ) and inappropriate medication use ( based on established criteria ) . RESULTS Residents were on an average of 5.32 medications .  Polypharmacy and inappropriate medication use were seen in 266 ( 58.6 % ) and 318 ( 70.0 % ) residents , respectively . There was significant association between polypharmacy and inappropriate medication use [ P < 0.001 , chi2 = 82.56 at 95 % confidence interval ( CI ) ] . The most common medication-related problems were the use of medication without proper indication ( n = 302 ) , significant potential for adverse drug reactions ( n = 281 ) and drug interactions ( n = 141 ) . CONCLUSION The prevalence of polypharmacy and inappropriate medication use is high in Singapore nursing homes . Current practice of medication use in the nursing homes may lead to significant adverse drug reactions and drug interactions . A multidisciplinary approach involving geriatricians , nursing home physicians , nurses and pharmacists may potentially reduce polypharmacy and inappropriate medication use in Singapore nursing homes Background Nursing home residents are mainly older people with multiple diseases and taking multiple medications . The quality use of medication and its association with health related quality of life ( HRQoL ) have not been reported in Malaysia . This study aims to investigate the association between the use of potentially inappropriate medications ( PIMs ) and the changes observed in the HRQoL among older nursing home residents . Methods A prospect i ve follow up study was conducted at four nongovernmental organization nursing homes in Penang , Malaysia . Older residents ( ≥65 years old ) taking at least one prescribed medication were included . Residents with PIMs were identified by using Screening Tool of Older Person ’s potentially inappropriate Prescriptions ( STOPP ) criteria . HRQoL was assessed using EuroQol-5 dimension ( EQ-5D ) and EuroQol-visual analog scale ( EQ-VAS ) at baseline and after a 3-month follow up . The association of PIMs with HRQoL was analyzed using Mann-Whitney U test . Results The median age of the 211 participants was 77 years ( interquartile range 72–82 years ) and the median number of prescription medicines was four ( interquartile range three to six ) . The prevalence of PIMs was 23.7 % and 18.6 % at baseline and 3 months later , respectively . The most commonly prescribed PIMs in decreasing order were first generation antihistamine , prescriptions of duplicate drug class , glibenclamide with type 2 diabetes mellitus , and anticholinergic to treat extrapyramidal side effects of neuroleptic medications . At baseline , there was no significant difference among residents with or without PIMs in each bracket of EQ-5D , EQ-5D index , or EQ-VAS scores . Comparison of the differences in the mean score index of EQ-5D between baseline and after 3 months also showed no statistically significant differences . Conclusion PIMs were found to be relatively common among older nursing home residents . However , no significant changes were observed in HRQoL among these residents . Further studies with a bigger sample size and longer follow up period are required to establish this association PURPOSE To develop a simple screen based on easily collectable measures to identify older people living in residential care facilities at high risk of falls . METHODS This prospect i ve study was conducted in seven residential care facilities in the U.K. Residents aged>60 years who were not bedbound or terminally ill participated .  Demographics , medical history , medication use , cognition ( mini mental state examination ( MMSE ) ) , function ( Barthel , balance and sit-to-st and ability ) and behavior ( neuro-psychiatric inventory ( NPI ) and impulsivity ) were recorded at baseline . Falls and injuries were prospect ively recorded over 6 months . Data were analyzed for differences between fallers and non-fallers and significant variables entered into logistic regression analysis . RESULTS Two hundred and forty residents completed the study . In the follow-up period , 50 % fell ≥1 times . Fallers had worse function , cognition , behavior and balance and took more medications . Falling in the past year , walking frame and hypnotic/anxiolytic and anti-depressant medication use were also associated with increased likelihood of falling . Logistic regression identified MMSE<17 , impulsivity score ≥ 2 , st and ing balance score<6 , requiring a walking frame , falling in the previous year and use of antidepressants and hypnotics/anxiolytics as independent and significant predictors of falls . The area under the receiver operating curve ( ROC ) for this model was 0.79 ( 95 % CI 0.73 - 0.84 ) . CONCLUSIONS This tool comprising multi-factorial measures provides a simple way of quantifying the probability with which a care home resident will fall over a 6-month period . The tool may also assist in guiding the development and targeting of interventions to prevent falls in this group BACKGROUND In a prospect i ve study of nursing home residents , we found adverse drug events ( ADEs ) to be common , serious , and often preventable . To direct prevention efforts at high-risk residents , information is needed on resident-level risk factors . METHODS Case-control study nested within a prospect i ve study of ADEs among residents in 18 nursing homes . For each ADE , we r and omly selected a control from the same home . Data were abstract ed from medical records on functional status , medical conditions , and medication use . RESULTS Adverse drug events were identified in 410 nursing home residents . Independent risk factors included being a new resident ( odds ratio [ OR ] , 2.8 ; 95 % confidence interval [ CI ] , 1.5 - 5.2 ) and taking anti-infective medications ( OR , 4.0 ; CI , 2.5 - 6.2 ) , antipsychotics ( OR , 3.2 ; CI , 2.1 - 4.9 ) , or antidepressants ( OR , 1.5 ; CI , 1.1 - 2.3 ) . The number of regularly scheduled medications was associated with increased risk of ADEs ; the OR associated with taking 5 to 6 medications was 2.0 ( CI , 1.2 - 3.2 ) ; 7 to 8 medications , 2.8 ( CI , 1.7 - 4.7 ) ; and 9 or more , 3.3 ( CI , 1.9 - 5.6 ) . Taking supplements or nutrients was associated with lower risk ( OR , 0.42 ; CI , 0.27 - 0.63 ) . Preventable ADEs occurred in 226 residents . Independent risk factors included taking opioid medications ( OR , 6.6 ; CI , 2.3 - 19.3 ) , antipsychotics ( OR , 4.0 ; CI , 2.2 - 7.3 ) , anti-infectives ( OR , 3.0 ; CI , 1.6 - 5.8 ) , antiepileptics ( OR , 2.2 ; CI , 1.1 - 4.5 ) , or antidepressants ( OR , 2.0 ; CI , 1.1 - 3.5 ) . Scores of 5 or higher on the Charlson Comorbidity Index were associated with increased risk of ADEs ( OR , 2.6 ; CI , 1.1 - 6.0 ) . The number of regularly scheduled medications was also a risk factor : the OR for 7 to 8 medications was 3.2 ( CI , 1.4 - 6.9 ) and for 9 or more , 2.9 ( CI , 1.3 - 6.8 ) . Residents taking nutrients or supplements were at lower risk ( OR , 0.27 ; CI , 0.14 - 0.50 ) . CONCLUSIONS It is possible to identify nursing home residents at high risk of having an ADE . Particular attention should be directed at new residents , those with multiple medical conditions , those taking multiple medications , and those taking psychoactive medications , opioids , or anti-infective drugs Objective : To study changes in drug use after admission to Dutch nursing homes . Setting . Six nursing homes near the city of Nijmegen , The Netherl and s. Design . Prospect i ve longitudinal study . Methods . All patients who had been newly admitted to the nursing home were included in the study . Age , gender , residence of the patients before admission , and indication were registered . All prescriptions were registered with start‐ date and end‐ date . The nomenclature and subcategory definitions used were those of the World Health Organisation Nordic Anatomical Therapeutic Chemical classification index ( ATC ) codes . Patients had a follow‐up of six weeks . Results . There was a minor , but statistically significant , increase in the mean number of drugs from 5.6 on admission to 5.8 six weeks later . Patients referred from a hospital and patients with a somatic indication were prescribed the highest number of drugs . On admission 5.5 % of the patients were not on medication at all , 48%were using 1‐2 drugs , and 46 % had been prescribed 6 or more drugs . Six weeks after admission , a significant increase in drug use was found in drugs for the nervous system , and drugs for the sensory organs . Conclusion . Increase in drug use does not necessarily have to reflect bad prescribing practice s. However , in this frail population , continuous drug review is needed to guarantee quality of prescribing and reduce unnecessary polypharmacy OBJECTIVES To evaluate the association between the Drug Burden Index ( DBI ) , a measure of a person 's total exposure to anticholinergic and sedative medications that includes principles of dose-response and maximal effect and is associated with impaired physical function in community-dwelling older people , and falls in residents of residential aged care facilities ( RACFs ) . DESIGN Data were drawn from participants in a r and omized controlled trial that investigated falls and fractures . SETTING RACFs in Sydney , Australia . PARTICIPANTS Study participants ( N=602 ; 70.9 % female ) were recruited from 51 RACFs . Mean age was 85.7 ± 6.4 , and mean DBI was 0.60 ± 0.66 . MEASUREMENTS Medication history was obtained on each participant . Drugs were classified as anticholinergic or sedative and a DBI was calculated . Falls were measured over a 12-month period . Comorbidity , cognitive impairment ( Mini-Mental State Examination ) and depression ( Geriatric Depression Scale ) were determined . RESULTS There were 998 falls in 330 individuals during a follow-up period of 574.2 person-years , equating to an average rate of 1.74 falls per person-year . The univariate negative binomial regression model for falls showed incidence rate ratios of 1.69 ( 95 % confidence interval (CI)=1.22 - 2.34 ) for low DBI ( < 1 ) and 2.11 ( 95 % CI=1.47 - 3.04 ) for high DBI ( ≥1 ) when compared with those who had a DBI of 0 . After adjusting for age , sex , history of falling , cognitive impairment , depression , use of a walking aid , comorbidities , polypharmacy , and incontinence , incident rate ratios of 1.61 ( 95 % CI=1.17 - 2.23 ) for low DBI and 1.90 ( 95 % CI=1.30 - 2.78 ) for high DBI were obtained . CONCLUSION DBI is significantly and independently associated with falls in older people living in RACFs . Interventional studies design ed for this population are needed to determine whether reducing DBI , through dose reduction or cessation of anticholinergic and sedative drugs , can prevent falls OBJECTIVES To evaluate the feasibility of developing consensus recommendations for appropriate prescribing for patients with advanced dementia using a new conceptual framework and to determine the frequency of inappropriate medication use based on these recommendations in a small sample of patients with advanced dementia . DESIGN Medication data were obtained using chart review . Recommendations for appropriate prescribing were achieved using a modified Delphi consensus panel . SETTING Three long-term care facilities . PARTICIPANTS Thirty-four patients with advanced dementia enrolled in the Palliative Excellence in Alzheimer Care Efforts Program were selected to evaluate medication use . Twelve geriatricians at the University of Chicago participated in the modified Delphi consensus panel . MEASUREMENTS Prescription and over-the-counter medications were recorded for the 34 patients . Following the modified Delphi process , medications were characterized into one of four categories for use in palliative care patients with advanced dementia : never appropriate , rarely appropriate , sometimes appropriate , or always appropriate . RESULTS Patients were taking an average of 6.5 medications at enrollment . Six patients were taking 10 or more medications daily . Consensus was reached ranking the appropriateness of 69 of 81 medic 
    Output:
    
The prevalence of  polypharmacy in LTCFs is high , varying widely between facilities , geographical locations and the definitions used .