Inappropriate Drug Use and Risk of Transition to Nursing Homes Among Community-Dwelling Older Adults

Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD 21201, USA.
Medical Care (Impact Factor: 3.23). 09/2006; 44(8):722-30. DOI: 10.1097/
Source: PubMed


Adverse events from inappropriate medications are preventable risk factors for nursing home admissions.
We sought to investigate the relationship between inappropriate medications in older adults and transitions to nursing home.
A retrospective cohort of Medicare beneficiaries with employer-sponsored supplemental health insurance was analyzed using a longitudinal data set of Medicare supplemental insurance claims. After a baseline year with no nursing home admissions, subjects were followed until the first month of transition to nursing home, loss to follow-up, or the end of the 24-month follow-up period. Survival analysis was used to compare the risk of nursing home transition among those with and without inappropriate drug use in the previous 3 months.
Of the 487,383 subjects in the cohort, 22,042 (4.5%) had a nursing home admission. Use of inappropriate drugs was associated with a 31% increase in risk of nursing home admission, compared with no use of inappropriate drugs (adjusted relative risk 1.31, 99% confidence interval [CI] 1.26-1.36). Analyses of individual drug classes showed the risk of nursing home admission was similar, or lower, for inappropriate drugs versus other drugs of the same class. For example, the relative risk of nursing home admission was 2.34 (99% CI 2.20-2.47) for inappropriate narcotics and 2.68 (99% CI 2.55-2.82) for other narcotics, compared with no narcotic use.
Inappropriate drug use was associated with increased risk of nursing home transition, but the increased risk may be explained by underlying patient conditions for which the drugs were prescribed rather than the inappropriate drug.

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    • "A number of studies have documented that the actual process of being admitted to a long-term care facility* is a significant life event for older adults and their families.(15,16) The preference for most older adults is to remain in their homes.(13,17) "
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    ABSTRACT: Objectives The objective of this study was to characterize patterns of formal health service utilization costs during older adults’ transition from community to institutional care. Methods Participants were 127 adults (age ≥ 65) from the British Columbia sample (N = 2,057) of the Canadian Study of Health and Aging who transitioned from community to institutional care between 1991 and 2001. Health service utilization costs were measured using Cost-Per-Day-At-Risk at five time points: > 12 months, 6–12 months, and ≤ 6 months preinstitutionalization, and ≤ 6 months and 6–12 months postinstitutionalization. Cost-Per-Day-At-Risk was measured for Continuing Care, Medical Services Plan, and PharmaCare costs by calculating total health service use over time, divided by the number of days the participant was alive. Results Significant differences in Cost-Per-Day-At-Risk were observed for Continuing Care, Medical Services Plan, and PharmaCare costs over time. All health service utilization costs increased significantly during the 6–12 months and ≤ 6 months prior to institutionalization. Postinstitutionalization Continuing Care costs continued to increase at ≤ 6 months before decreasing at 6–12 months, while decreases occurred for Medical Services Plan and PharmaCare costs relative to preinstitutionalization costs. Conclusions The increases in costs observed during the year prior to institutionalization, characterized by a flurry of health service utilization, provide evidence of distinct cost patterns over the transition period.
    06/2014; 17(2):45-52. DOI:10.5770/cgj.17.82
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    • "This increasing risk of inappropriate drug use, together with the prevalence of chronic diseases, may cause problems such as drug resistance and side effects [3] [4]. Inappropriate drug use is very common among elderly patients and may cause preventable side effects, hospitalization, death, and waste of resources [5] [6] [7] [8]. As the number of elderly people increases in the world population, the quality and safety of drug prescribing are becoming a global health service problem [9]. "
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    ABSTRACT: Aim: Our aim was to detect older patients who were prescribed inappropriate drugs according to START/STOPP criteria in primary care. Materials and method: Patients aged over 65, admitted to health center no. 5 in Afyon, were included. The files of the subjects were surveyed retrospectively for the final one year in the digital environment, using the Family Medicine Information System. The files surveyed allowed us to list the drugs they used in the past year and to detect inappropriate drug use. Results: The number of patients that took part in this study was 325 (average age: 73.23 ± 6.44 years). We found that, among these participants, 48 patients (14.8%) were using drugs inappropriately according to STOPP criteria. Conclusion: Further focus on avoiding inappropriate drug use will allow clinicians and other health professionals to reduce side effects and other complications. In patients aged over 65, there is a need to attach particular importance to inappropriate drug use, drug interactions, and avoidance of side effects.
    The Scientific World Journal 06/2013; 2013(10):165873. DOI:10.1155/2013/165873 · 1.73 Impact Factor
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    • "As regards the drugs/therapeutic classes most identified as inappropriate, 36.8% (7/19) of the studies [22,27-29,31-33] described the inappropriate medication as individual drugs, two reported them as therapeutic classes [21,34]; nine presented rankings of classes and individual drugs [23-25,30,35-39], and one did not describe the inappropriate medications [26]. "
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    ABSTRACT: Inappropriate medication use (IMU) by elderly people is a public health problem associated with adverse effects on health. There are a number of methods for identifying IMU, some involving clinical judgment and others, consensually generated lists of drugs to be avoided. This review aims to describe studies that used information from insurance company and social security administrative databases to assess IMU among community-dwelling elderly and to present the risk factors most often associated with IMU. The paper search was conducted in Medline and Embase, using descriptors combined with free terms in the title or abstract. The limits applied were: publication date from January 1990 to June 2010, species (human) and publication type (excluding editorials, letters and reviews). Excluded were: case studies; studies in hospitals, nursing homes, or hospital emergency departments; studies of specific drugs or groups of drugs; studies exclusively of subgroups of ill, frail elderly or rural populations. Additional studies were identified from reference lists. Data were selected and extracted after independent reading by two of the authors, with disagreements resolved by a third author. The primary outcome assessed was prevalence of IMU, defined as the proportion of elderly who received at least one inappropriate medication. Of the 628 studies, 19 met the inclusion criteria, 78.9% of them conducted in the USA. All papers included used explicit criteria of inappropriateness, most commonly Beers criteria (73.7%) in their three versions (1991, 1997 and 2002). Other methods used included Zhan, which is derived from on Beers criteria and was applied in 21% of the papers selected. The study found that prevalence of IMU ranged from 11.5% to 62.5%. Only 68.4% of the studies included examined inappropriate use-related factors, the most important being female sex, advanced age and larger number of drugs. The results show that the prevalence of IMU among community-dwelling elderly is high and depends partly on the method used to evaluate improper use. Besides the diversity of methods, other factors, such as patient sex, age and number of drugs used concurrently, appear to have influenced the estimates of IMU.
    BMC Geriatrics 11/2011; 11(1):79. DOI:10.1186/1471-2318-11-79 · 1.68 Impact Factor
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