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

Lisa L. Dwyer, MPHLisa L. Dwyer, MPH

Robin E. Remsburg, PhD, APRN, BC Robin E. Remsburg, PhD, APRN, BC

Division of Health Care StatisticsDivision of Health Care Statistics

National Center for Health StatisticsNational Center for Health Statistics

AcademyHealth Annual Research Meeting 2006: Seattle, WAAcademyHealth Annual Research Meeting 2006: Seattle, WA

June 26, 2006June 26, 2006

2

IntroductionIntroduction

Previous study reports that medication use is Previous study reports that medication use is

highest among the institutionalized elderly.highest among the institutionalized elderly.

• comorbiditiescomorbidities

• pharmacodynamics and pharmacokineticspharmacodynamics and pharmacokinetics

• inappropriate medications inappropriate medications

Greater potential for adverse events Greater potential for adverse events

3

IntroductionIntroduction

Current estimates of the number and Current estimates of the number and

types of medications taken by the types of medications taken by the

nursing home elderly are lacking.nursing home elderly are lacking.

4

Research QuestionsResearch Questions

What was the average number of What was the average number of medications taken by elderly nursing home medications taken by elderly nursing home residents?residents?

What were the most frequent therapeutic What were the most frequent therapeutic classes taken by these residents?classes taken by these residents?

What percentage of residents took What percentage of residents took benzodiazepines and barbiturates before the benzodiazepines and barbiturates before the Medicare Part D implementation? Medicare Part D implementation?

5

2004 National Nursing Home Survey2004 National Nursing Home Survey

Survey itemsSurvey items

• medications taken 24 hrs before facility interviewmedications taken 24 hrs before facility interview standing or routine medications, or PRNsstanding or routine medications, or PRNs

up to 25 medicationsup to 25 medications

• medications taken regularly but not 24 hrs medications taken regularly but not 24 hrs before facility interviewbefore facility interview up to 25 medicationsup to 25 medications

• reason medications were prescribedreason medications were prescribed

6

2004 National Nursing Home Survey2004 National Nursing Home Survey

Medication dataMedication data

• found in medication administration recordsfound in medication administration records

did not collect dosage, frequency, routedid not collect dosage, frequency, route

• provided by respondent during facility interviewprovided by respondent during facility interview

• entered into CAPI system by interviewerentered into CAPI system by interviewer

• were appended with drug characteristicswere appended with drug characteristics

7

2004 National Nursing Home Survey2004 National Nursing Home Survey

Drug characteristics appendedDrug characteristics appended

• generic namegeneric name

• ingredientsingredients

• therapeutic classestherapeutic classes

• composition statuscomposition status

• prescription statusprescription status

• DEA statusDEA status

8

2004 National Nursing Home Survey 2004 National Nursing Home Survey

Results: Results:

• 1.3 million elderly current residents1.3 million elderly current residents

26% male, 74% female26% male, 74% female

mean age = 85 y.o. (standard error = 0.11)mean age = 85 y.o. (standard error = 0.11)

male = 82 y.o. (S.E. = 0.19)*, female = 86 y.o. (S.E. = 0.11)*male = 82 y.o. (S.E. = 0.19)*, female = 86 y.o. (S.E. = 0.11)*

87% white, 11% black, 2% other87% white, 11% black, 2% other

Preliminary Results.

*Statistically significant difference, p < 0.01

9

2004 National Nursing Home Survey 2004 National Nursing Home Survey

Mean number of medications Mean number of medications

• Overall = 8.7 RxsOverall = 8.7 Rxs

male = 8.5 Rxs*male = 8.5 Rxs*

female = 8.8 Rxs*female = 8.8 Rxs*

• 41% of elderly residents took more than 9 Rxs.41% of elderly residents took more than 9 Rxs.

Preliminary Results.

Statistically significant difference, p<0.05

10

Therapeutic ClassTherapeutic Class % of residents % of residents (n=1,315,597)(n=1,315,597)

% ther. classes % ther. classes (n=11,528,485)(n=11,528,485)

Vitamins or minerals Vitamins or minerals 56.556.5 6.56.5

LaxativesLaxatives 48.348.3 5.55.5

AntidepressantsAntidepressants 46.346.3 5.35.3

Non-narcotic analgesicsNon-narcotic analgesics 45.845.8 5.25.2

AntipyreticsAntipyretics 43.543.5 5.05.0

Acid or peptic disordersAcid or peptic disorders 42.642.6 4.94.9

DiureticsDiuretics 36.836.8 4.24.2

AntiarthriticsAntiarthritics 32.532.5 3.73.7

Replenishers/regulators of electrolytesReplenishers/regulators of electrolytes 31.531.5 3.63.6

Antipsychotics or antimanicsAntipsychotics or antimanics 24.824.8 2.82.8

Top Therapeutic Classes Taken by Elderly ResidentsTop Therapeutic Classes Taken by Elderly Residents

Preliminary Results.

11

2004 National Nursing Home Survey 2004 National Nursing Home Survey

Medicare Part D exclusions include: Medicare Part D exclusions include:

• barbiturates < 1% of residentsbarbiturates < 1% of residents

• benzodiazepines = 13% of residentsbenzodiazepines = 13% of residents

• prescription vitamin/mineralsprescription vitamin/minerals

• nonprescription drugsnonprescription drugs

Preliminary Results.

12

2004 National Nursing Home Survey 2004 National Nursing Home Survey SummarySummary

• Preliminary analysis reveals that many residents Preliminary analysis reveals that many residents took > 9 medications.took > 9 medications.

• Metabolic/nutrients, pain relievers, gastrointestinal Metabolic/nutrients, pain relievers, gastrointestinal agents, and CNS drugs were taken frequently.agents, and CNS drugs were taken frequently.

• Residents who took benzodiazepines (13%) may be Residents who took benzodiazepines (13%) may be affected by the Medicare Part D exclusions; affected by the Medicare Part D exclusions; residents who took prescription vitamins/minerals residents who took prescription vitamins/minerals and nonprescription products may be affected as and nonprescription products may be affected as well.well.

Preliminary Results.

13

2004 National Nursing Home Survey 2004 National Nursing Home Survey

Significance/relevance Significance/relevance

• Patient safety Patient safety

• Evaluation of Medicare Part D implementationEvaluation of Medicare Part D implementation

health outcomes of residentshealth outcomes of residents

change(s) in clinical practicechange(s) in clinical practice

policy makers’ response policy makers’ response

Preliminary Results.

14

2006 NCHS Data Users Conference2006 NCHS Data Users Conference