Potentially Inappropriate Medication Use in the Community-Dwelling Elderly

Abstract

Overall inappropriate medication use in elderly patients remains a serious problem. Despite challenges in using explicit criteria for assessing inappropriate medications for elderly patients, such criteria can be applied to population-based surveys to identify opportunities to improve quality of care and patient safety. Enhancements of existing data sources to include dosage, duration, and indication may augment national improvement and monitoring efforts.

Factors associated with use of medications with potential to impair cognition or cholinesterase inhibitors among Alzheimer's disease patients

“…A similar prevalence was found in a European population [14]. The patient characteristics associated with a higher risk of receiving Beers-criteria medications include poor overall health [6,[10][11][12], depression [14], polypharmacy [6,[10][11][12]14], and possibly female gender [6,[10][11][12]. Age has had mixed results as a predictive factor, with some studies reporting older patients to be at lower risk [12][13][14] and others at higher risk [10,15,16] of receiving a Beers-criteria medication.…”

“…The patient-based prevalence of potentially inappropriate use of medications found in these studies ranges from 14% to 40% with higher percentages generally observed in nursing homes and lower percentages seen in community samples [10,11], although 2 Canadian studies observed lower rates in nursing homes than in the community [12,13]. One representative study found that 21% of community-dwelling elderly patients received at least 1 potentially inappropriate medication [6]. A similar prevalence was found in a European population [14].…”

“…These criteria, first published in 1991 [2] and updated in 1997 [3] and 2003 [4] were originally developed for nursing home patients. However, they have been used to evaluate patients in board and care facilities [5], outpatient settings [6,7], and home health care settings [8] as well as nursing homes [9]. The criteria were developed initially by Beers on the basis of a literature review and evaluated by experts in geriatrics and pharmacology using a modified Delphi method [3].…”

Receipt of High Risk Medications among Elderly Enrollees in Medicare Advantage Plans

“…2,3 HRM use in the geriatric population is associated with increases in morbidity, mortality, hospitalization, inpatient length of stays, and health care spending. [4][5][6] HRMs in the elderly are broadly defined as medications that should be avoided among patients 65 years of age or older, because the associated adverse effects outweigh potential benefits or because safer alternatives are available, 7 a principle codified most prominently by the Beers 8 and Zhan 9 criteria. To improve the quality of drug prescribing in the elderly, the Centers for Medicare and Medicaid Services (CMS) requires all Medicare Advantage (MA) health plans to report publicly on the prescribing rates of HRMs, as defined by the Healthcare Effectiveness Data and Information Set's (HEDIS) "Drugs to Avoid in the Elderly" quality measure.…”

“…To improve the quality of drug prescribing in the elderly, the Centers for Medicare and Medicaid Services (CMS) requires all Medicare Advantage (MA) health plans to report publicly on the prescribing rates of HRMs, as defined by the Healthcare Effectiveness Data and Information Set's (HEDIS) "Drugs to Avoid in the Elderly" quality measure. The term HRM is often used interchangeably with 'potentially inappropriate medication', 8,9 a phrase that acknowledges the complexity inherent in assessing the quality of patient-specific drug management decisions among heterogeneous patient populations. In this manuscript, we use 'high risk,' because that is the specification of the quality measure used in the analysis.…”