Pharmacy Practice Faculty Publications
Comparison of the Association Between Disease Burden and Inappropriate Medication Use Across Three Cohorts of Older Adults
Document Type
Article
Publication Date
12-2004
Journal Title
The American Journal of Geriatric Pharmacotherapy
ISSN
1543-5946
Volume
2
Issue
4
First Page
237
Last Page
247
DOI
http://dx.doi.org/10.1016/j.amjopharm.2004.12.003
PubMed ID
15903282
Abstract
Background:
Use of potentially inappropriate medications is common in nursing facilities (NFs), in which frail older adults are particularly vulnerable to adverse drug effects. The community-dwelling elderly are generally healthier and have lower overall rates of medication use, but their prescribed medications are not subjected to the same degree of regulatory scrutiny as those of residents in NFs. Frail elderly (FE) adults who are nursing home eligible but are receiving home- and community-based services (HCBS) constitute a distinct group sharing a high disease burden and high levels of medication use with the NF population.
Objective:
The goal of this study was to examine the relationship between disease burden and inappropriate medication use in these 3 cohorts, with adjustment for demographic and clinical differences.
Methods:
We performed retrospective analyses of Medicaid claims data from May 2000 through April 2001 to identify 3 cohorts of Kansas Medicaid beneficiaries: community-dwelling older adults (the ambulatory cohort); persons receiving HCBS through the Kansas Frail Elderly Program (the FE cohort); and elderly NF residents (the NF cohort). Demographic, clinical, and medication data were extracted from the Medicaid claims data. Unconditionally inappropriate medications were identified using the 1997 Beers criteria. The Cumulative Illness Rating Scale for Geriatrics was used to calculate the disease burden sum, classified as 0 or 1, 2 or 3, 4 or 5, or ≥6 disease categories. Odds ratios for inappropriate medication use at each level of disease burden in each cohort were derived using multivariable models adjusted for demographic and clinical factors, including overall level of medication use.
Results:
The final sample included 3185 persons in the 3 cohorts (1163 ambulatory, 858 FE, 1164 NF). Inappropriate medication use was determined to have occurred in 21%, 48%, and 38% of the respective cohorts and was highest in FE cohort members with the greatest disease burden (61%). For the ambulatory and FE cohorts, inappropriate medication use rose as the disease burden increased. The same was not observed in the NF cohort, in whom rates of inappropriate medication use showed little variation regardless of disease burden.
Conclusions:
The relationship between disease burden and inappropriate medication use varied by setting. Those members of the FE cohort with the highest disease burden had the greatest risk for inappropriate medication use.
Keywords
Disease, medication, older adults, elderly, drug therapy, practice patterns, comorbidity
Recommended Citation
Rigler, Sally K.; Perera, Subashan; Jachna, Carolyn; Shireman, Theresa I.; and Eng, Marty L., "Comparison of the Association Between Disease Burden and Inappropriate Medication Use Across Three Cohorts of Older Adults" (2004). Pharmacy Practice Faculty Publications. 85.
https://digitalcommons.cedarville.edu/pharmacy_practice_publications/85