Inappropriate Medication in a National Sample of US Elderly Patients Receiving Home Health Care

Department of Public Health, Weill Cornell Medical College, 402 E. 67th St., New York, NY 10065, USA.
Journal of General Internal Medicine (Impact Factor: 3.42). 10/2011; 27(3):304-10. DOI: 10.1007/s11606-011-1905-4
Source: PubMed


With substantial morbidity and functional impairment, older patients receiving home health care are especially susceptible to the adverse effects of unsafe or ineffective medications. Home health agencies’ medication review and reconciliation services, however, provide an added mechanism of medication safety that could offset this risk.
To estimate the prevalence of potentially inappropriate medications (PIMs) among current elderly home health patients in the US.
Cross-sectional analysis using data from the 2007 National Home and Hospice Care Survey.
3,124 home health patients 65 years of age or older on at least one medication.
Prevalence and classification of PIM use and the association between PIM use and patient and home health agency characteristics.Key Results In 2007, 38% (95% CI: 36-41) of elderly home health patients were taking at least one PIM. Polypharmacy was associated with an increased risk of PIM use; admission to home health care from a nursing home or other sub-acute facility (compared to admission from the community) and a payment source other than Medicare or Medicaid were associated with a decreased risk of PIM use.
The prevalence of PIM use in older home health patients is high despite potential mechanisms for improved safety. Policies to improve the review and reconciliation processes within home health agencies and to improve physician-home health clinician collaboration are likely needed to lower the prevalence of PIM use in older home health patients.

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Available from: Yuhua Bao, Mar 13, 2014
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    • "Wahruch et al. [25] and Ruggiero et al. [38] reported the same findings. Moreover, numerous studies in the literature [1,32,38-41] have demonstrated a significant relationship between polypharmacy and PIM use. As Bao et al. [41] noted, it is not surprising that polypharmacy is a factor strongly associated with PIM use since patients taking many medications have a better chance of receiving an inappropriate prescription and are more likely to have multiple pathologies, hospitalizations, and consultations with multiple doctors of various specialties, which could lead to prescriptions of PIMs. "
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    ABSTRACT: Background: The use of potentially inappropriate medications (PIM) among the elderly is a serious public health problem because it is intrinsically linked to increased morbidity and mortality, causing high costs to public health systems. This study's objective was to verify the prevalence of and the factors associated with the use of PIMs by elderly Brazilians in institutional settings. Methods: We performed a transversal study, by consulting the case files of elderly people living in Long Term Care for the Elderly (LTC) in towns in the State of São Paulo, Brazil, as well as structured interviews with the nurses responsible for them.We identified PIMs using the list of recently updated Beers criteria developed by a group of specialists from the American Geriatrics Society (AGS), who reviewed the criteria based on studies with high scientific evidence levels. We defined the factors studied to evaluate the association with PIM use prior to the statistical analyses, which were the chi-square test and multiple logistic regression. Results: Among the elderly who used drugs daily, 82.6% were taking at least one PIM, with antipsychotics (26.5%) and analgesics (15.1%) being the most commonly used. Out of all the medications used, 32.4% were PIMs, with 29.7% of these being PIMs that the elderly should avoid independent of their condition, 1.1% being inappropriate medication for older adults with certain illnesses or syndromes, and 1.6% being medications that older adults should use with caution. In the multivariate analysis, the factors associated with PIM use were: polypharmacy (p = 0.0187), cerebrovascular disease (p = 0.0036), psychiatric disorders (p < 0.0001) and dependency (p = 0.0404). Conclusions: The results of this study showed a high prevalence of PIM use in institutionalized elderly Brazilian patients. and the associated factors were polypharmacy, psychiatric disorders, cerebrovascular diseases and dependency.
    Full-text · Article · May 2013 · BMC Geriatrics
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