Determinants of Potentially Inappropriate Medication Use among Community-Dwelling Older Adults

Health Serv Res. 2017 Aug;52(4):1534-1549. doi: 10.1111/1475-6773.12562. Epub 2016 Sep 29.

Abstract

Objective: To examine the determinants of potentially inappropriate medication (PIM) use.

Data sources/study setting: U.S. nationally representative data on (n = 16,588) noninstitutionalized older adults (age ≥65) with drug use from the 2006-2010 Medical Expenditure Panel Survey.

Study design: We operationalized the 2012 Beers Criteria to identify PIM use during the year, and we examined associations with individual-level characteristics hypothesized to be quality enabling or related to need complexity.

Principal findings: Almost one-third (30.9 percent) of older adults used a PIM. Multivariate results suggest that poor health status and high-PIM-risk conditions were associated with increased PIM use, while increasing age and educational attainment were associated with lower PIM use. Contrary to expectations, lack of a usual care source of care or supplemental insurance was associated with lower PIM use. Medication intensity appears to be in the pathway between both quality-enabling and need-complexity characteristics and PIM use.

Conclusion: Our results suggest that physicians attempt to avoid PIM use in the oldest old but have inadequate focus on the high-PIM-risk conditions. Educational programs targeted to physician practice regarding high-PIM-risk conditions and patient literacy regarding medication use are potential responses.

Keywords: Beers Criteria; Potentially inappropriate medications; older adults.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Aged, 80 and over
  • Female
  • Homes for the Aged*
  • Humans
  • Interviews as Topic
  • Logistic Models
  • Male
  • Medication Errors
  • Polypharmacy*
  • Potentially Inappropriate Medication List*
  • Qualitative Research
  • Risk Factors
  • United States