Potentially Inappropriate Medication Prescriptions among Elderly Nursing Home Residents: Their Scope and Associated Resident and Facility Characteristics

Abstract

Objective. To estimate the scope of potentially inappropriate medication prescriptions (PIRx) among elderly residents in U.S. nursing homes (NHs), and to examine associated resident and facility characteristics. Data Sources. The 1996 Medical Expenditure Panel Survey Nursing Home Component (MEPS NHC), a survey of a nationally representative sample of NHs and residents. Study Design. The PIRx, defined by Beers's consensus criteria (1991, 1997), was identified using up to a year's worth of NH prescribed medicine data for each resident. The study sample represented 1.6 million NH residents (n 5 3,372). Results. At a minimum, 50 percent of all residents aged 65 or older, with an NH stay of three months or longer received at least one PIRx in 1996. The most common PIRx involved propoxyphene, diphenhydramine, hydroxyzine, oxybutynin, amitriptyline, cyproheptadine, iron supplements, and ranitidine. Resident factors associated with greater odds of PIRx were Medicaid coverage, no high school diploma, and nondementia mental disorders. Facility factors were more beds and lower RN-to-resident ratio. Factors associated with lower odds of PIRx were fewer medications, residents with communication problems, and being in an accredited NH. Onsite availability of pharmacists or mental health providers was not related. Implications. With quality of care and patient safety as major public health concerns, effective policies are needed to avoid PIRx occurrences and improve the quality of prescribing among elderly residents in NHs. Additional studies are needed to determine the impact of PIRx on this NH population.

Health outcomes associated with potentially inappropriate medication use in older adults

“…In a study of 211 Medicare enrollees, Rask et al (2005) found that PIMs were not associated with DRP; indeed, the majority of DRPs in this study occurred in persons prescribed non-PIMs. Researchers in several recent controlled studies, however, have begun to show a link with the Beers criteria and poorer patient outcomes (Klarin, Wimo, & Fastbom, 2005;Lau et al, 2004). Lau et al found PIM use was associated with increased risk of hospitalization and increased risk of deaths among NH residents.…”

“…PIMs are medications identified through expert panel review as having risks that outweigh benefits (Beers et al, 1991). Since the early 1990s, the prevalence of PIMs has been examined in a (Lau, Kasper, Potter, & Lyles, 2004), outpatient (Aparasu & Sitzman, 1999Curtis et al, 2004), acute care (Onder et al, 2005), and community settings (Zhan et al, 2001). For research purposes, use of explicit criteria is generally preferred over the use of implicit criteria applied by expert reviewers.…”

“…number of long-term care (Lau, Kasper, Potter, & Lyles, 2004), outpatient (Aparasu & Sitzman, 1999;Curtis et al, 2004), acute care (Onder et al, 2005), and community settings (Zhan et al, 2001). For research purposes, use of explicit criteria is generally preferred over the use of implicit criteria applied by expert reviewers.…”

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

“…Expert consensus panels have defined potentially inappropriate medications (PIMs) as medications that generally should be avoided among patients 65 years or older either because they are ineffective or because associated adverse effects outweigh potential benefits and a safer alternative exists. 3,4 Recent studies examining the prevalence of PIM use in various medical settings in the US have found that at least one PIM was prescribed in 8-13% of ambulatory visits, 5,6 50% of nursing home residents, 7 and 17% of emergency department visits. 8 PIM use among elderly home health patients in the US remains unknown.…”

Efectividad de una intervención en la mejora del uso de medicamentos en centros residenciales geriátricos

“…[2][3][4] En España, las personas mayores de 65 años representan el 17 % de la población total, mientras que el gasto generado en su atención representa el 50 % del total y alrededor del 70 % de la factura farmacéutica (Fuente: Instituto Nacional de Estadística).Diversos artículos consultados, sobre el uso de medicamentos dedicados a la atención de las personas mayores, estudian el abordaje de fármacos específicos en determinadas enfermedades crónicas o en su consumo inapropiado, pero la mayoría, son coincidentes en demostrar perfiles de sobre-utilización, que ocasionan un mayor riesgo en desarrollar efectos adversos, interacciones medicamentosas y errores en la medicación. [5][6][7][8][9] Por tanto, a todos los actores sanitarios se les plantea la necesidad de reducir el consumo injustificado de fármacos, optimizar su eficiencia y promover estrategias orientadas a facilitar el uso racional del medicamento, con criterios de seguridad y eficacia. [10][11][12][13][14][15][16] Desde el Servicio Catalán de la Salud (CatSalut), análogo a otras comunidades autonómicas, se están realizando diversas estrategias que intentan abordar este problema de actuación, tanto en los centros residenciales geriátricos como en sus entidades proveedoras de referencia.…”