Incident use and outcomes associated with potentially inappropriate medication use in older adults

Seema D. Dedhiya PhD , Emily Hancock PharmD , Bruce A. Craig PhD , Caroline C. Doebbeling MD, MSc , Joseph Thomas III PhD
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引用次数: 111

Abstract

Background: Most studies of potentially inappropriate medication (PIM) use among older adults have focused on prevalence rather than incidence.

Objectives: The goals of this study were to determine the 1-year incidence of PIM use among elderly Indiana Medicaid residents of nursing homes and to examine associations between incident PIM use and hospitalization and mortality.

Methods: A retrospective analysis was conducted using Indiana Medicaid enrollment and administrative claims files. Individuals were included if they were Medicaid eligible and aged ≥65 years as of January 2003 and received nursing home services in each month of 2003 or until death in 2003. Individuals also had to receive nursing home services from October 2002 through December 2002 for inclusion in the sample. To focus analysis on incident PIM use, individuals who received any PIM prescription medication from October 2002 through December 2002 were excluded from the sample, as were those not prescribed any new medication in 2003. PIMs were identified using the 2003 Beers criteria. Associations between incident PIM use and hospitalization and mortality were assessed using logistic regression models after controlling for other risk factors. Potential selection bias was examined using bivariate probit models.

Results: The study sample consisted of 7594 individuals (mean age, 83.07 years). A majority of the sample was female (76.5%), white (89.7%), and widowed (58.8%). Most individuals received care in nursing homes located in urban areas (5306 [69.9%]) and in the central region of Indiana (2838 [37.4%]). One-year incidence of PIM use was 42.1%. Incident PIM users were more likely to be hospitalized (odds ratio [OR] = 1.27; 95% CI, 1.10–C1.46) and more likely to die (OR = 1.46; 95% CI, 1.31–C1.62) in the 12 months after first receiving a PIM than nonusers, even after adjusting for demographic and clinical risk factors.

Conclusions: Incident PIM use was high among these elderly Indiana Medicaid residents of nursing homes. Individuals who began use of a PIM were at a higher risk of hospitalization and of dying.

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老年人意外用药及与潜在不适当用药相关的结果
背景:大多数关于老年人潜在不适当药物(PIM)使用的研究关注的是患病率而不是发病率。目的:本研究的目的是确定印第安纳州老年医疗补助居民疗养院中PIM使用的1年发生率,并检查PIM使用与住院和死亡率之间的关系。方法:对印第安纳州医疗补助登记和行政索赔档案进行回顾性分析。如果个人符合医疗补助资格,且截至2003年1月年龄≥65岁,并且在2003年每个月或直到2003年死亡之前接受了养老院服务,则包括在内。从2002年10月到2002年12月接受养老院服务的个人也被纳入样本。为了集中分析PIM使用事件,从2002年10月到2002年12月接受任何PIM处方药的个体被排除在样本之外,2003年没有开任何新药物的个体也被排除在外。pim是使用2003年Beers标准确定的。在控制其他危险因素后,使用逻辑回归模型评估PIM使用与住院和死亡率之间的关系。使用二元概率模型检验潜在的选择偏差。结果:研究样本包括7594人,平均年龄83.07岁。大多数样本为女性(76.5%),白人(89.7%)和丧偶(58.8%)。大多数人在城市地区(5306人[69.9%])和印第安纳州中部地区(2838人[37.4%])的养老院接受护理。1年PIM使用率为42.1%。突发PIM使用者更有可能住院(优势比[OR] = 1.27;95% CI, 1.10-C1.46),更容易死亡(OR = 1.46;95% CI, 1.31-C1.62),在首次接受PIM后的12个月内,即使在调整了人口统计学和临床危险因素后,也比未接受PIM的患者要好。结论:在印第安纳州养老院里接受医疗补助的老年人中,PIM使用率较高。开始使用PIM的个体住院和死亡的风险更高。
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来源期刊
American Journal Geriatric Pharmacotherapy
American Journal Geriatric Pharmacotherapy GERIATRICS & GERONTOLOGY-PHARMACOLOGY & PHARMACY
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