title: Epidemiology of drug-disease interactions in older veteran nursing home residents.
abstract: OBJECTIVE
  To describe the prevalence of and factors associated with drug-disease interactions (DDIs) in older nursing home residents according to the American Geriatrics Society 2012 Beers Criteria.
  
  
  METHODS
  Cross-sectional.
  
  
  METHODS
  Fifteen Veterans Affairs Community Living Centers.
  
  
  METHODS
  Individuals aged 65 and older with a diagnosis of dementia or cognitive impairment, a history of falls or hip fracture, heart failure (HF), a history of peptic ulcer disease (PUD), or Stage IV or V chronic kidney disease (CKD).
  
  
  METHODS
  Medications that could exacerbate the above conditions (DDIs).
  
  
  RESULTS
  Three hundred sixty-one of 696 (51.9%) eligible residents had one or more DDIs. None involved residents with a history of PUD, one involved a resident with CKD, and four occurred in residents with HF. Of 540 residents with dementia or cognitive impairment, 50.7% took a drug that could exacerbate these conditions; the most commonly involved medications were antipsychotics (35.4%) and benzodiazepines (14.4%). Of 267 with a history of falls or hip fracture, 67.8% received an interacting medication, with selective serotonin reuptake inhibitors (33.1%), antipsychotics (30.7%), and anticonvulsants (25.1%) being most commonly involved. Using separate multivariable logistic regression models, factors associated with DDIs in dementia or cognitive impairment and falls or fractures included age 85 and older (adjusted odds ratio (aOR) = 0.38, 95% confidence interval (CI) = 0.24-0.60 and aOR = 0.48, 95% CI = 0.24-0.96, respectively), taking five to eight medications (aOR = 2.06, 95% CI = 1.02-4.16 and aOR = 4.76, 95% CI = 1.68-13.5, respectively), taking nine or more medications (aOR = 1.99, 95% CI = 1.03-3.85 and aOR = 3.68, 95% CI = 1.41-9.61, respectively), and being a long-stay resident (aOR = 1.80, 95% CI = 1.04-3.12 and aOR = 2.35, 95% CI = 1.12-4.91, respectively).
  
  
  CONCLUSIONS
  DDIs were common in older nursing home residents with dementia or cognitive impairment or a history of falls or fractures.
authors.affiliation: Veterans Affairs Pharmacy Benefits Management Services, Hines, Illinois; Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Sherrie L
authors.initials: SL
authors.lastname: Aspinall
authors.forename: Xinhua
authors.initials: X
authors.lastname: Zhao
authors.forename: Todd P
authors.initials: TP
authors.lastname: Semla
authors.forename: Francesca E
authors.initials: FE
authors.lastname: Cunningham
authors.forename: Allison M
authors.initials: AM
authors.lastname: Paquin
authors.forename: Mary Jo
authors.initials: MJ
authors.lastname: Pugh
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Schmader
authors.forename: Roslyn A
authors.initials: RA
authors.lastname: Stone
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Hanlon
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003704:Dementia / Q000453:epidemiology; D004347:Drug Interactions; D005260:Female; D006333:Heart Failure / Q000453:epidemiology; D006620:Hip Fractures / Q000453:epidemiology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology; D008297:Male; D009735:Nursing Homes; D010437:Peptic Ulcer / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D014728:Veterans
keywords: Beers criteria; drug-disease interactions; nursing homes