Trends in Number and Appropriateness of Prescription Medication Utilization among Community-Dwelling Older Adults in the US: 2011-2020

Abstract

Background Contemporary data on the quantity and quality of medication use among older adults are lacking. This study examined recent trends in number and appropriateness of prescription medication use among older adults in the US. Method Data from the National Health and Nutrition Examination Survey (NHANES) between 2011 and March 2020 were used and 6336 adult participants aged 65 and older were included. We examined the number of prescription medication, prevalence of polypharmacy (≥5 prescription drugs), use of potentially inappropriate medication (PIM), and use of recommended medications (ACEI/ARBs plus beta-blockers among patients with heart failure and ACEI/ARBs among patients with albuminuria). Results There has been a slight increase in the prevalence of polypharmacy (39.3% in 2011-2012 to 43.8% in 2017-2020, p for trend= 0.32). Antihypertensive, antihyperlipidemic, antidiabetic medications, and antidepressants are the most commonly used medications. There was no substantial change in the use of PIM (17.0% to 14.7%). Less than 50% of older adults with heart failure received ACEI/ARBs plus beta-blockers (44.3% in 2017-2020) and approximately 50% patients with albuminuria received ACEI/ARBs (54.0 in 2017-2020), with no improvement over the study period. Polypharmacy, older age, female, and lower socioeconomic status generally were associated with greater use of PIM but lower use of recommended medications. Conclusions The medication burden remained high among older adults in the US and the appropriate utilization of medications did not improve in the recent decade. Our results underscore the need for greater attentions and interventions to the quality of medication use among older adults.