title: Medication assessments by care managers reveal potential safety issues in homebound older adults.
abstract: BACKGROUND
  Over-the-counter (OTC) medications, benzodiazepines, and barbiturates are not covered under many Medicare drug benefit plans; hence, their use by homebound older adults is largely unreported. Furthermore, the tiered design of Medicare drug formularies may in fact promote the use of older but potentially inappropriate medications. Little is known about the use of these medications in the homebound older adult population.
  
  
  OBJECTIVE
  To determine the prevalence of the use by homebound older adults of OTC drugs, dietary supplements (vitamins, minerals, and herbal products), Part D-excluded medications (benzodiazepines and barbiturates), and potentially inappropriate medications (according to Beers criteria).
  
  
  METHODS
  Patients were enrollees in a home and community-based Medicaid waiver provider. All clients were older than 65 and were dually eligible for Medicare and Medicaid. All clients met Florida Medicaid's medical and financial criteria for nursing home placement. The medication list was obtained by geriatric care managers during a home assessment.
  
  
  RESULTS
  A total of 3911 older adults (mean [SD] age 83.6 [8.0] years) were taking an average of 9.9 [4.8] drugs. Of these individuals, 74.5% were using an OTC medication, 41.9% were using a dietary supplement, 29.6% were using a benzodiazepine or barbiturate, and 25.2% were using at least 1 potentially inappropriate medication.
  
  
  CONCLUSIONS
  Based on data gathered by a geriatric care management assessment, we found that most of the homebound older adults enrolled in our study used medications not included in their Medicare drug benefit. The use of potentially inappropriate medications was also common in this population. Future drug safety initiatives involving the elderly will benefit from engaging care managers in identifying and addressing the potential hazards posed by commonly used prescribed and nonprescribed medications.
authors.affiliation: Department of Clinical Sciences, University of Central Florida College of Medicine, Orlando, FL, USA. adam.golden@ucf.edu
authors.forename: Adam G
authors.initials: AG
authors.lastname: Golden
authors.forename: Dingxi
authors.initials: D
authors.lastname: Qiu
authors.forename: Bernard A
authors.initials: BA
authors.lastname: Roos
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001463:Barbiturates / Q000008:administration & dosage / Q000009:adverse effects; D001569:Benzodiazepines / Q000008:administration & dosage / Q000009:adverse effects; D019587:Dietary Supplements / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000706:statistics & numerical data*; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D015577:Geriatric Assessment; D018577:Homebound Persons; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data; D007356:Insurance, Pharmaceutical Services; D008297:Male; D008329:Managed Care Programs; D004366:Nonprescription Drugs / Q000008:administration & dosage* / Q000009:adverse effects; D010346:Patient Care Management; D015995:Prevalence
chemical_list: D001463:Barbiturates; D004366:Nonprescription Drugs; D001569:Benzodiazepines