Potentially inappropriate medications and risk of hospitalization in retirees: analysis of a US retiree health claims database.
One important health outcome of inappropriate medication use in the elderly is risk of hospitalization. We examined this relationship over 3 years in a retiree health claims database to determine the strength of this association using alternative definitions of potentially inappropriate medications. Prescription and hospitalization claims for US retirees from a single large corporation were examined over the 3-year period, 2003-5. Purging the database of non-employees (dependents, spouses), employees aged <65 years (who were not Medicare-eligible) and retirees not covered for the full 3-year period left a sample of 7459 retirees. Respondents' medications were categorized according to two lists of 'drugs to avoid': Beers (2003 update) and the National Committee for Quality Assurance (NCQA). Logistic regression models were developed to examine risk of hospitalization in 2005 relative to use of potentially inappropriate medications across different periods of follow-up. Retirees taking one or more of the potentially inappropriate medications on the Beers or NCQA lists were 1.8-1.9 times more likely to have a hospital admission in models that adjusted for age, gender, number of prescriptions overall and aggregate disease severity. Risk of hospitalization increased in a dose-response relationship according to number of potentially inappropriate medications. Consistency in the strength of the association between 'drugs to avoid' and hospital admission across different definitions of inappropriate medication use suggests the finding is robust. Findings from the retiree cohort provide further evidence for the inappropriateness of these medications among the elderly.
Albert
Steven M
SM
Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 120 DeSoto Avenue, Pittsburgh, PA 15261, USA. smalbert@pitt.edu
Colombi
Alberto
A
Hanlon
Joseph
J
D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D018450:Disease Progression; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008508:Medication Errors / Q000706:statistics & numerical data*; D012179:Retirement; D012307:Risk Factors; D013997:Time Factors; D014481:United States
Arch Intern Med. 1991 Sep;151(9):1825-32
1888249
Lancet. 2007 Jul 14;370(9582):173-184
17630041
J Am Geriatr Soc. 1999 Jan;47(1):30-9
9920227
J Am Geriatr Soc. 2006 Oct;54(10):1516-23
17038068
JAMA. 2005 Mar 16;293(11):1348-58
15769968
Clin Pharmacol Ther. 1998 Dec;64(6):684-92
9871433
Arch Intern Med. 2003 Dec 8-22;163(22):2716-24
14662625
J Manag Care Pharm. 2006 Sep;12(7):537-45
16981799
JAMA. 1994 Jul 27;272(4):292-6
8028142
Am J Geriatr Pharmacother. 2004 Jun;2(2):102-11
15555486
Drugs Aging. 2005;22(1):69-82
15663350
J Am Geriatr Soc. 2001 Feb;49(2):200-9
11207875
Am J Geriatr Pharmacother. 2004 Jun;2(2):92-101
15555485
Ann Pharmacother. 2007 Mar;41(3):438-47
17311835
J Palliat Med. 2007 Jun;10(3):686-95
17592980
Clin Pharmacol Ther. 2009 Jan;85(1):94-7
18987619
Int J Clin Pharmacol Ther. 2008 Feb;46(2):72-83
18218287
Arch Intern Med. 1997 Jul 28;157(14):1531-6
9236554
J Am Geriatr Soc. 2002 Jan;50(1):26-34
12028243
CMAJ. 1997 Feb 1;156(3):385-91
9033421