title: Evolution of medication use in Jerusalem elders: Results from the Jerusalem Longitudinal Study.
abstract: BACKGROUND
  While overall rates of medication use have been increasing over time, less is known about how medication use changes within individuals as they age.
  
  
  OBJECTIVE
  The aim of this study was to evaluate changes in medication use and predictors of medication accrual among community-dwelling elders followed for a 7-year period, from age 70 +/- 1 years to age 77 +/- 1 years.
  
  
  METHODS
  The study was a community-based, longitudinal, cohort study. The study group consisted of 280 patients from the Jerusalem Longitudinal Study, a population-based sample of Jerusalem residents born in 1920-1 who underwent extensive evaluation in 1990-1 and again in 1997-8. The main outcome measure of the study was the change in the total number of medications taken between baseline and follow-up. Medication use was assessed by home interviews.
  
  
  RESULTS
  Half of the sample were men. Medication use more than doubled over the 7-year study period, from a mean of 2.0 to 5.3 medications per patient (p < 0.001), and 57 patients (20%) increased their total drug use by six or more medications. Vitamins, minerals and cardiovascular medications were the most commonly prescribed medications at follow-up, and accounted for approximately half of the total increase in medication use. On multivariable logistic regression analyses, decline in self-rated health was the strongest predictor of above-median increases in medication use (odds ratio [OR] 3.2; 95% CI 1.8, 6.2). The only nonclinical predictor of above-median increases in medication use was good social engagement at baseline (OR 1.8; 95% CI 1.1, 3.1).
  
  
  CONCLUSIONS
  Medication use in Jerusalem elders grew rapidly over the 1990s, more than doubling in volume over a 7-year period. While health status was the factor most strongly predictive of the degree of change, the magnitude of increase for elders as a whole suggests major changes in prescribing practices over this interval.
authors.affiliation: Division of Geriatrics, San Francisco Veterans Affairs (VA) Medical Center and University of California, San Francisco, California 94121, USA. mike.steinman@ucsf.edu
authors.forename: Michael A
authors.initials: MA
authors.lastname: Steinman
authors.forename: Yoram
authors.initials: Y
authors.lastname: Maaravi
authors.forename: Louise C
authors.initials: LC
authors.lastname: Walter
authors.forename: Robert
authors.initials: R
authors.lastname: Hammerman-Rozenberg
authors.forename: Jochanan
authors.initials: J
authors.lastname: Stessman
mesh_terms: D000367:Age Factors; D000368:Aged; D017281:Cost of Illness; D004363:Drug Utilization / Q000639:trends*; D005260:Female; D006304:Health Status; D006801:Humans; D007407:Interviews as Topic; D007557:Israel; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D019338:Polypharmacy; D010818:Practice Patterns, Physicians' / Q000639:trends*; D012111:Residence Characteristics; D012919:Social Behavior