Factors associated with potentially inappropriate drug utilization in a sample of rural community-dwelling older adults.
BACKGROUND
Many medications present special risks when used by older adults (ie, those aged > or = 65 years) and are considered potentially inappropriate for this population. The Beers criteria are often used to identify such medications. Past research has documented that use of Beers drugs is common among older adults.


OBJECTIVE
The aim of this work was to examine factors associated with potentially inappropriate drug use among rural community-dwelling older adults using a conceptual framework adapted from the Andersen-Newman behavioral model of health service use.


METHODS
This was a population-based, cross-sectional survey. Data were collected via face-to-face home interviews between 2002 and 2004. Rural community-dwelling older adults residing in a single county in North Carolina were eligible. Potentially inappropriate drug use was operationalized using the Beers criteria. Data concerning predisposing (ie, age, sex, race, education, and marital status), enabling (ie, social support and insurance status), need (ie, disability and history of major depression, hypertension, osteoarthritis, back problems, or other comorbidities), and utilization factors (ie, number of medications used) were collected.


RESULTS
Data were gathered from 892 people, with information on medication use available for 800. Two hundred thirteen of these 800 participants (26.6%) used > or = 1 Beers drug. Compared with individuals who used no Beers drugs, those who used > or = 1 Beers drug reported lower levels of social support (odds ratio [OR], 0.94; 95% CI, 0.90-0.99) and higher levels of disability (OR, 1.48; 95% CI, 1.11-1.97), used more medications (OR, 1.07; 95% CI, 1.01-1.13), and were more likely to have a history of major depression (OR, 1.67; 95% CI, 1.05-2.66), hypertension (OR, 1.58; 95% CI, 1.07-2.33), osteoarthritis (OR, 1.58; 95% CI, 1.09-2.29), and back problems (OR, 1.72; 95% CI, 1.19-2.47).


CONCLUSIONS
As suggested by the Andersen-Newman model, the risk of potentially inappropriate drug use is highest among those with the greatest medication needs, as evidenced by poorer health status in this sample of rural community-dwelling older patients.
Blalock
Susan J
SJ
School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina 27599-7360, USA. s_blalock@unc.edu
Byrd
John E
JE
Hansen
Richard A
RA
Yamanis
Thespina J
TJ
McMullin
Katherine
K
DeVellis
Brenda M
BM
DeVellis
Robert F
RF
Panter
A T
AT
Kawata
Ariane K
AK
Watson
Lea C
LC
Jordan
Joanne M
JM
D000328:Adult; D000368:Aged; D015897:Comorbidity; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D004358:Drug Therapy / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000941:ethics / Q000639:trends*; D005260:Female; D006299:Health Services for the Aged / Q000639:trends; D006801:Humans; D008297:Male; D008508:Medication Errors / Q000706:statistics & numerical data / Q000639:trends*; D016017:Odds Ratio; D012111:Residence Characteristics; D012307:Risk Factors; D012424:Rural Population; D011795:Surveys and Questionnaires