Date of Award

2000

Degree Type

Thesis

Degree Name

Master of Science (MS)

Department

Pharmaceutical Sciences

First Advisor

Paul Larrat

Abstract

Objective: This study was designed to study the inappropriate medication utilization in patients aged 65 years or older residing in a long term care facility; to examine patterns in the use of inappropriate medications during the stay in the facility; and to determine predictors of inappropriate medication use. Design: Retrospective, cross-sectional study Methods: We used the Systematic Assessment of Geriatric Drug Use via Epidemiology (SAGE) database that includes data from all Medicaid/Medicare certified nursing homes located in 5 US states. We examined data collected with the federally mandated Minimum Data Set along with the sociodemographic, clinical and treatment information during the period October 1995 to September1996 (n =44,562). Measurements: Inappropriate medication was defined according to Beers' criteria. Use of inappropriate medication was determined at admission and at ninety days. We calculated incidence of discontinuation, initiation, and continuance of these medications over the ninety-day period in the nursing home. A logistic regression model provided estimates of Odds Ratio (OR) for the predictors of inappropriate use of drugs. Results: Thirty-three percent of the residents were receiving at least one inappropriate medication on admission to the long-term care facility. Of the 29,082 remaining in long term care facility ninety days after admission, 16% on an inappropriate medication at admission had the medication discontinued, while 18% of non-users at admission initiated an inappropriate agent during the 90 days, a net result of 39% using an inappropriate agent at 90 days. The number of medications taken by the patient, race, age and level of cognitive impairment were found to be associated with the use of inappropriate medications. Discussion: Overall use of inappropriate medication increased significantly during the first 90 days of residence in a long-term care facility. Inappropriate use of long acting benzodiazepines and analgesics was of particular concern. These findings highlight the need for careful patient medication regimen assessment and medication prescribing upon long term care admission.

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