Adverse outcomes associated with inappropriate drug use in nursing homes.
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.
Perri
Matthew
M
College of Pharmacy, University of Georgia, Athens, GA 30602-0002, USA. mperri@mail.rx.uga.edu
Menon
Ajit M
AM
Deshpande
Aparna D
AD
Shinde
Shashank B
SB
Jiang
Rong
R
Cooper
James W
JW
Cook
Christopher L
CL
Griffin
Samuel C
SC
Lorys
Robyn A
RA
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D017723:Drug Utilization Review / Q000706:statistics & numerical data*; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D005845:Georgia; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008508:Medication Errors / Q000706:statistics & numerical data*; D009735:Nursing Homes / Q000706:statistics & numerical data*; D019338:Polypharmacy; D012189:Retrospective Studies