Abstract
Background and Objective
One important health outcome of inappropriate medication use in the elderly is risk of hospitalization. We examined this relationship over 3 years in a retiree health claims database to determine the strength of this association using alternative definitions of potentially inappropriate medications.
Methods
Prescription and hospitalization claims for US retirees from a single large corporation were examined over the 3-year period, 2003–5. Purging the database of non-employees (dependents, spouses), employees aged <65 years (who were not Medicare-eligible) and retirees not covered for the full 3-year period left a sample of 7459 retirees. Respondents’ medications were categorized according to two lists of ‘drugs to avoid’: Beers (2003 update) and the National Committee for Quality Assurance (NCQA). Logistic regression models were developed to examine risk of hospitalization in 2005 relative to use of potentially inappropriate medications across different periods of follow-up.
Results
Retirees taking one or more of the potentially inappropriate medications on the Beers or NCQA lists were 1.8–1.9 times more likely to have a hospital admission in models that adjusted for age, gender, number of prescriptions overall and aggregate disease severity. Risk of hospitalization increased in a dose-response relationship according to number of potentially inappropriate medications.
Conclusion
Consistency in the strength of the association between ‘drugs to avoid’ and hospital admission across different definitions of inappropriate medication use suggests the finding is robust. Findings from the retiree cohort provide further evidence for the inappropriateness of these medications among the elderly.
Similar content being viewed by others
References
Spinewine A, Schmader KE, Barber N, et al. Appropriate prescribing in elderly people: how can it be measured and optimized? Lancet 2007; 370: 173–84
Beers MH, Ouslander JG, Rollingher I, et al. Explicit criteria for determining potentially inappropriate medication use in the elderly. Arch Intern Med 1991; 151: 1825–32
Beers MH. Explicit criteria for determining potentially inappropriate medication use in the elderly: an update. Arch Intern Med 1997; 157: 1531–6
Fick DM, Cooper JW, Wade WE, et al. Updating the Beers criteria for potentially inappropriate medication use in the elderly: results of a US consensus panel of experts. Arch Intern Med 2003; 163: 2716–24
McLeod PJ, Huang AR, Tamblyn RM, et al. Defining inappropriate practices in prescribing for elderly people: a national consensus panel. CMAJ 1997; 156: 385–91
Gallagher P, Ryan C, Byrne S, et al. STOPP (Screening Tool for Older Person’s Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment): consensus validation. Int J Clin Pharmacol Ther 2008; 46: 72–83
Laroche ML, Charmes JP, Bouthier F, et al. Inappropriate medications in the elderly. Clin Pharmacol Ther 2009; 85: 94–7
NCQA 2007 [online]. Available from URL: http://www.ncqa.org/Portals/0/Newsroom/2007/Drugs_Avoided_Elderly.pdf [Accessed 2009 May 6]
Fialova D, Topinkova E, Gambassi G, et al. Potentially inappropriate medication use among elderly home care patients in Europe. JAMA 2005; 293: 1348–58
Hanlon JT, Schmader KE, Ruby CM, et al. Suboptimal prescribing in older inpatients and outpatients. J Am Geriatr Soc 2001; 49: 200–9
Steinman MA, Landefeld CS, Rosenthal GE, et al. Polypharmacy and prescribing quality in older adults. J Am Geriatr Soc 2006; 54: 1516–23
Jano E, Aparasu RR. Healthcare outcomes associated with Beers’ criteria: a systematic review. Ann Pharmacother 2007; 41: 438–48
Fillenbaum GG, Hanlon JT, Landerman LR, et al. Impact of inappropriate drug use on health services utilization among representative older community-dwelling residents. Am J Geriatr Pharmacother 2004; 2: 92–101
Klarin A, Wimo A, Fastbom J. The association of inappropriate drug use with hospitalization and mortality: a population-based study ofthe very old. Drugs Aging 2005; 22: 69–82
Fick DM, Waller JL, Maclean JR, et al. Potentially inappropriate medication use in a Medicare managed care population: association with higher costs and utilization. J Managed Care Pharm 2001; 7: 407–13
Hanlon JT, Horner RD, Schmader KE, et al. Benzodiazepine use and cognitive function among community dwelling elderly. Clin Pharmacol Ther 1998; 64: 684–92
Leipzig RM, Cumming RG, Tinetti ME. Drugs and falls in older people: a systematic review and meta-analysis: I. Psychotropic drugs. J Am Geriatr Soc 1999; 47: 30–9
Thomson Reuters (Medstat). Field definition guide. Cambridge (MA): Thomson Reuters, 2006
GAO. Prescription drugs and the elderly: many still receive potentially harmful drugs despite recent improvements. Washington, DC: Government Accounting Office, 1996
Willcox SM, Himmelstein DU, Woolhandler S. Inappropriate drug prescribing for the community-dwelling elderly. JAMA 1994; 272: 292–6
Hanlon JT, Schmader KE, Boult C, et al. Use of inappropriate prescription drugs by older people. J Am Geriatr Soc 2002; 50: 26–34
Fahlman C, Lynn J, Finch M, et al. Potentially inappropriate medication use by Medicaid + Choice Beneficiaries in the last year of life. J Palliative Med 2007; 10: 686–95
Pugh MJ, Hanlon JT, Zeber JE, et al. Assessing potentially inappropriate prescribing in the elderly Veterans Affairs population using the HEDIS 2006 quality measure. J Managed Care Pharmacy 2006; 12: 537–45
Aparasu RR, Mort JR. Prevalence, correlates, and associated outcomes of potentially inappropriate psychotropic use in community-dwelling elderly. Am J Geriatr Pharmacother 2004; 2: 102–11
Acknowledgements
Chongji Wei assisted with data pre-processing. PPG Industries, Inc., provided retiree data through Healthcare Business of Thomson Reuters.
This study was supported in part by National Institute of Aging grants R01 AG027017 and P30 AG024827 and VA Health Services Research grant IIR-06-062.
The authors have no conflicts of interest that are directly relevant to the content of this study.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Albert, S.M., Colombi, A. & Hanlon, J. Potentially Inappropriate Medications and Risk of Hospitalization in Retirees. Drugs Aging 27, 407–415 (2010). https://doi.org/10.2165/11315990-000000000-00000
Published:
Issue Date:
DOI: https://doi.org/10.2165/11315990-000000000-00000