Inappropriate medication prescribing in residential care/assisted living facilities.
OBJECTIVE
To identify the extent to which inappropriately prescribed medications (IPMs) are administered to older patients in residential care/assisted living (RC/AL) facilities and to describe facility and resident factors associated with receipt of one or more IPMs.


METHODS
Cross-sectional study of a stratified, representative sample of 193 facilities in four states.


METHODS
We identified representative geographic regions within Florida, New Jersey, North Carolina, and Maryland and drew from within them a stratified random sample of 193 RC/AL facilities. Three subtypes of facilities were included in the sample: small homes (<16 beds), larger "new-model" homes, and larger "traditional" homes.


METHODS
Within each larger home, a random sample of residents aged 65 and older was approached for consent; in smaller homes all residents were approached. The overall enrollment rate was 92%; 2,078 residents were enrolled.


METHODS
Questionnaires and on-site observations were used to gather data on facility administration and staffing and resident characteristics. All prescription and nonprescription medications taken at least 4 of the 7 days before data collection were taken from medication administration records and coded for analysis. IPM designation was based on modification of a list developed by Beers et al. and currently used by nursing home surveyors.


RESULTS
The majority of RC/AL patients were taking five or more medications; 16.0% of these patients were receiving IPMs. The most common IPMs were oxybutynin, propoxyphene, diphenhydramine, ticlopidine, doxepin, and dipyridamole. In multivariate analyses, using generalized estimating equations, IPM use was associated with the number of medications received, smaller facility bed size, moderate licensed practical nurse turnover, absence of dementia, low monthly fees, and absence of weekly physician visits.


CONCLUSIONS
IPMs remain a problem in long-term care, but rates in these RC/AL settings compare favorably with those reported for other frail older populations, suggesting that use of medications with severe adverse effects may be waning. Regular physician facility visits may improve prescribing, as will attention to high-risk groups such as individuals on multiple medications.
Sheps Center for Health Services Research, School of Medicine, University of North Carolina at Chapel Hill, 725 Airport Road, Chapel Hill, NC 27599 USA. psloane@med.unc.edu
Philip D
PD
Sloane
Sheryl
S
Zimmerman
Lori C
LC
Brown
Timothy J
TJ
Ives
Joan F
JF
Walsh
D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D004363:Drug Utilization / Q000592:standards*; D005260:Female; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008508:Medication Errors / Q000706:statistics & numerical data*; D012112:Residential Facilities / Q000592:standards*; D012307:Risk Factors