title: Impact of inappropriate drug use on mortality and functional status in representative community dwelling elders.
abstract: BACKGROUND
  The predictive validity of Drug Utilization Review (DUR) and drugs-to-avoid criteria in elders is unknown.
  
  
  OBJECTIVE
  To evaluate the relationship between use of inappropriate drugs as determined by these explicit criteria and mortality and decline in functional status in community dwelling elders.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  The fourth wave (3234 participants) of the Duke Established Populations for Epidemiologic Studies of the Elderly.
  
  
  METHODS
  Two sets of inappropriate drug-use criteria: (1) DUR with respect to dosage, duplication, drug-drug interactions, duration, and drug-disease interactions; and (2) Beers-modified criteria regarding drugs-to-avoid were applied to drug use reported in an in-home interview. Death was identified from the National Death Index; change in four functional status measures (basic self-care, intermediate self-care, complex self-management, physical function) was determined during the following 3 years.
  
  
  RESULTS
  Use of inappropriate drugs identified by either set of criteria was not significantly associated with mortality. The drugs-to-avoid criteria identified no significant associations between use of these drugs and decline in functional status. With DUR criteria, however, the association between use of inappropriate drugs and basic self-care was significant and pronounced among those with drug-drug or drug-disease interaction problems (Adj. OR 2.04; 95% CI 1.32-3.16).
  
  
  CONCLUSIONS
  Identifying the impact of inappropriate drug use may depend on the criteria applied. Further studies are needed that measure additional outcomes and use alternate measures of inappropriate drug use.
authors.affiliation: Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN 55455, USA. hanlo004@tc.umn.edu
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Hanlon
authors.forename: Gerda G
authors.initials: GG
authors.lastname: Fillenbaum
authors.forename: Maggie
authors.initials: M
authors.lastname: Kuchibhatla
authors.forename: Margaret B
authors.initials: MB
authors.lastname: Artz
authors.forename: Chad
authors.initials: C
authors.lastname: Boult
authors.forename: Cynthia R
authors.initials: CR
authors.lastname: Gross
authors.forename: Judith
authors.initials: J
authors.lastname: Garrard
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Schmader
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D017723:Drug Utilization Review; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D008508:Medication Errors; D009026:Mortality; D009657:North Carolina; D019338:Polypharmacy; D011237:Predictive Value of Tests; D012651:Self Medication