Transcript Medication Practices for the Elderly in U.S. Nursing Homes

Medication Practices for the Elderly
in U.S. Nursing Homes
Lisa L. Dwyer, MPH
Robin E. Remsburg, PhD, APRN, BC
Division of Health Care Statistics
National Center for Health Statistics
AcademyHealth Annual Research Meeting 2006: Seattle, WA
June 26, 2006
Introduction
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Previous study reports that medication use is
highest among the institutionalized elderly.

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comorbidities
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pharmacodynamics and pharmacokinetics
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inappropriate medications
Greater potential for adverse events
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Introduction
Current estimates of the number and
types of medications taken by the
nursing home elderly are lacking.
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Research Questions

What was the average number of
medications taken by elderly nursing home
residents?
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What were the most frequent therapeutic
classes taken by these residents?
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What percentage of residents took
benzodiazepines and barbiturates before the
Medicare Part D implementation?
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2004 National Nursing Home Survey
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Survey items
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medications taken 24 hrs before facility interview
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standing or routine medications, or PRNs
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up to 25 medications
medications taken regularly but not 24 hrs
before facility interview
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up to 25 medications
reason medications were prescribed
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2004 National Nursing Home Survey
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Medication data
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found in medication administration records
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did not collect dosage, frequency, route
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provided by respondent during facility interview
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entered into CAPI system by interviewer
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were appended with drug characteristics
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2004 National Nursing Home Survey
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Drug characteristics appended
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generic name
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ingredients
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therapeutic classes
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composition status
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prescription status
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DEA status
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Preliminary Results.
2004 National Nursing Home Survey
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Results:
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1.3 million elderly current residents
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26% male, 74% female
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mean age = 85 y.o. (standard error = 0.11)
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male = 82 y.o. (S.E. = 0.19)*, female = 86 y.o. (S.E. = 0.11)*
87% white, 11% black, 2% other
*Statistically significant difference, p < 0.01
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Preliminary Results.
2004 National Nursing Home Survey
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Mean number of medications
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Overall = 8.7 Rxs
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male = 8.5 Rxs*
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female = 8.8 Rxs*
41% of elderly residents took more than 9 Rxs.
Statistically significant difference, p<0.05
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Preliminary Results.
Top Therapeutic Classes Taken by Elderly Residents
% of residents
% ther. classes
(n=1,315,597)
(n=11,528,485)
Vitamins or minerals
56.5
6.5
Laxatives
48.3
5.5
Antidepressants
46.3
5.3
Non-narcotic analgesics
45.8
5.2
Antipyretics
43.5
5.0
Acid or peptic disorders
42.6
4.9
Diuretics
36.8
4.2
Antiarthritics
32.5
3.7
Replenishers/regulators of electrolytes
31.5
3.6
Antipsychotics or antimanics
24.8
2.8
Therapeutic Class
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Preliminary Results.
2004 National Nursing Home Survey
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Medicare Part D exclusions include:
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barbiturates < 1% of residents
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benzodiazepines = 13% of residents
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prescription vitamin/minerals
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nonprescription drugs
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Preliminary Results.
2004 National Nursing Home Survey
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Summary
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Preliminary analysis reveals that many residents
took > 9 medications.
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Metabolic/nutrients, pain relievers, gastrointestinal
agents, and CNS drugs were taken frequently.
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Residents who took benzodiazepines (13%) may be
affected by the Medicare Part D exclusions;
residents who took prescription vitamins/minerals
and nonprescription products may be affected as
well.
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Preliminary Results.
2004 National Nursing Home Survey
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Significance/relevance
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Patient safety
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Evaluation of Medicare Part D implementation
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health outcomes of residents
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change(s) in clinical practice
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policy makers’ response
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2006 NCHS Data Users Conference
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