Changing patterns in medication use with increasing probability of death for older Medicare beneficiaries.
OBJECTIVE
To determine whether use of symptom relief drugs (e.g., antidepressants, anxiolytics, opioid analgesics, sleep aids) rises and use of two commonly prescribed classes of chronic medications (statins and osteoporosis drugs) falls with greater probability of death for older Medicare beneficiaries.


METHODS
Pooled cross-sectional study.


METHODS
Noninstitutionalized older Medicare population in 2000 to 2005.


METHODS
Community-dwelling Medicare beneficiaries aged 65 and older (N=20,233).


METHODS
Use of medications measured according to dichotomous flags; intensity of use by annual medication fills. Annual probability of death modeled using logistic regression and stratified into seven groups with predicted probabilities of death that range from less than 5% to greater than 50%. Prevalence of use and intensity (mean prescription fills per month) were computed for each class of medication.


RESULTS
For symptom relief medications, there is relatively constant use with increasing probability of death, along with greater intensity of use. For the two chronic medications, there was a monotonic decrease in use but at a relatively constant intensity. Decline in statin use ranged from 34.4% in the lowest mortality stratum to 17.6% for those in the highest (P<.001). Use of osteoporosis drugs fell from 10.4% to 6.6% over the same range (P<.001).


CONCLUSIONS
Greater intensity of use of symptom relief medications with increasing probability of death is consistent with hypothesized use. The different profile for chronic medications suggests that the time to benefit is being considered regarding therapy initiation, which results in lower use.
Shaffer
Thomas
T
Peter Lamy Center on Drug Therapy and Aging, School of Pharmacy, University of Maryland, Baltimore, Maryland 21201, USA. tshaffer@rx.umaryland.edu
Simoni-Wastila
Linda
L
Toler
Wendy
W
Stuart
Bruce
B
Doshi
Jalpa A
JA
D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D006306:Health Surveys; D017051:Hospice Care / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D008297:Male; D006278:Medicare; D009026:Mortality; D014481:United States / Q000453:epidemiology
D000701:Analgesics, Opioid; D014151:Anti-Anxiety Agents; D000928:Antidepressive Agents; D050071:Bone Density Conservation Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D006993:Hypnotics and Sedatives