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GERIATRICS

Adverse Outcomes Associated with Inappropriate Drug Use in Nursing Homes

Professor and Associate Head for Community Practice, College of Pharmacy, University of Georgia, Athens, GA

Ajit M Menon, BPharm PhD

Senior Research Associate, Roger Green and Associates, New Hope, PA

Aparna D Deshpande, BPharm PhD

Senior Research Associate, Roger Green and Associates

Shashank B Shinde, PhD

Consultant, Health Products Research, White House, NJ

Rong Jiang, MS

Data Analyst, Chicago Association for Research and Education in Science, Hines, IL

James W Cooper, PhD

Professor, College of Pharmacy, University of Georgia

Christopher L Cook, PharmD PhD

Clinical Assistant Professor, College of Pharmacy, University of Georgia

Samuel C Griffin, MD

Family Practitioner, Athens Primary Care, Athens, GA

Robyn A Lorys, PharmD

Clinical Assistant Professor, College of Pharmacy, University of Georgia

Reprints: Dr. Perri, College of Pharmacy, University of Georgia, Athens, GA 30602-0002, fax 706/542-5228, mperri{at}mail.rx.uga.edu

BACKGROUND: Little empirical evidence exists regarding the influence and outcomes of inappropriate medication use among elderly nursing home residents.

OBJECTIVE: To identify the prevalence of inappropriate medication use among elderly patients in Georgia nursing homes using the Beers criteria and identify the relationship between inappropriate drug use and the likelihood of an adverse health outcome.

METHODS: A cohort design was used to review 1117 patient medical records in 15 Georgia nursing homes with a high risk of polypharmacy. Prevalence of inappropriate medication use among elderly patients, as defined by the Beers criteria, was estimated. The adverse health outcomes of hospitalizations, emergency department visits, or deaths were identified from Medicaid claims data.

RESULTS: A total of 519 (46.5%) patients received at least one inappropriate medication and 143 (12.8%) patients experienced at least one adverse health outcome. Logistic regression revealed that the total number of medications taken (OR 1.139, 95% CI 1.105 to 1.173) significantly increased the likelihood of receiving an inappropriate drug, while having a diagnosis of "dementia" (OR 0.748, 95% CI 0.565 to 0.991) decreased the likelihood. Inappropriate medication use increased the likelihood of experiencing at least one adverse health outcome more than twofold (OR 2.34, 95% CI 1.61 to 3.40). Propoxyphene use alone was significantly associated with the occurrence of an adverse health outcome (OR 2.39, 95% CI 1.54 to 3.71).

CONCLUSIONS: Inappropriate drug use was common in our study cohort. Inappropriate use of medication in the elderly, particularly propoxyphene, is associated with a higher risk of adverse health outcomes.

Key Words: adverse health outcomes, Beers criteria, inappropriate drug use, Medicaid

Published Online, January 25, 2005. www.theannals.com, DOI 10.1345/aph.1E230

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