Factors predicting change in prescription and nonprescription drug use in a community-residing black and white elderly population

doi:10.1016/0895-4356(95)00563-3

Journal of Clinical Epidemiology

Volume 49, Issue 5, May 1996, Pages 587-593

https://doi.org/10.1016/0895-4356(95)00563-3 Get rights and content

Abstract

The current study identifies characteristics that predict change in use of prescription and nonprescription drugs over a period of 3 years. A modified health care services use model was applied to information obtained from a probability-based sample of black (n = 1778) and white (n = 1446) community-resident elderly, interviewed in 1986–1987 and 1989–1990. Analysis was by means of logistic and ordinary least-squares regression, with sample weights and design effects taken into account. The number of users and average number of prescription drugs used increased over the 3 years, and was best predicted by extent of prior drug use, older age, white race, poorer health, and number of health care visits. Conversely, nonprescription drug use declined significantly, and was best predicted by prior use, white race, and female gender. The reduced use of prescription drugs by blacks as compared to whites is of concern, suggesting that attention is needed to assure equitable access to prescription drugs.

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Cited by (56)

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2012, Primary Care - Clinics in Office Practice
Citation Excerpt :
Polypharmacy has been investigated frequently in the elderly.5–9 Several risk factors for polypharmacy have been identified and include increased age, white race, increased numbers of health care visits, supplemental insurance, and seeing multiple providers.5,10 In addition, several characteristics related to health increase the risk for polypharmacy, including overall poorer health status, depression, hypertension, anemia, asthma, angina, diverticulosis, osteoarthritis, gout, diabetes mellitus, and the use of 9 or more medications.5
Electronic Prescribing and Other Forms of Technology to Reduce Inappropriate Medication Use and Polypharmacy in Older People: A Review of Current Evidence
2012, Clinics in Geriatric Medicine
Citation Excerpt :
Individuals over 65, who account for less than 15% of the US population, consumed 33% of prescription medicines and 40% of over-the-counter medicines.22 Polypharmacy in older patients has been related to demographic factors, health status, and access to health care,23 including factors such as white race and education,24 poorer health, number of health care visits,25 and multiple providers of health care.26 Polypharmacy may describe prescribing of many drugs (appropriately) or too many drugs (inappropriately).27
Polypharmacy in nursing home residents in the United States: Results of the 2004 National Nursing Home Survey
2010, American Journal Geriatric Pharmacotherapy
Background: Despite the need for and benefits of medications, polypharmacy (defined here as concurrent use of ≥9 medications) in nursing home residents is a concern. As the number of medications taken increases, so does the risk for adverse events. Monitoring polypharmacy in this population is important and can improve the quality of nursing home care.
Objectives: The aims of this article were to estimate the use of polypharmacy in residents of nursing homes in the United States, to examine the associations between select resident and facility characteristics and polypharmacy, and to determine the leading therapeutic subclasses included in the polypharmacy received by these nursing home residents.
Methods: This was a retrospective, cross-sectional study of a nationally representative sample of US nursing home residents in 2004; the outcome was use of polypharmacy. The 2004 National Nursing Home Survey was used to collect medication data and other resident and facility information. Resident characteristics included age, sex, race, primary payment source, number of comorbidities, number of activities of daily living (ADLs) for which the resident required assistance, and length of stay (LOS) since admission. Facility characteristics included ownership and size (number of beds).
Results: Of 13,507 nursing home residents who received care, 13,403 had valid responses for all 9 independent variables in the analyses. The prevalence of polypharmacy among nursing home residents in 2004 was ~40%. A multiple regression model controlling for resident and facility factors revealed that the odds of receiving polypharmacy were higher for residents who were female (odds ratio [OR] = 1.10; 95% CI, 1.00–1.20), were white, had Medicaid as a primary payer, had >3 comorbidities (OR = 1.57–5.18; 95% CI, 1.36–6.15), needed assistance with <4 ADLs, had an LOS since admission of 3 to <6 months (OR = 1.25; 95% CI, 1.04–1.50), and received care in a small, not- for-profit facility (data not shown for reference levels [OR = 1.00]). The most frequently reported medications for residents who received polypharmacy included gastrointestinal agents (laxatives, 47.5%; agents for acid/peptic disorders, 43.3%), drugs that affect the central nervous system (antidepressants, 46.3%; antipsychotics or antimanics, 25.9%), and pain relievers (nonnarcotic analgesics, 43.6%; antipyretics, 41.2%; antiarthritics, 31.2%).
Conclusions: Despite awareness of polypharmacy and its potential consequences in older patients, results of our analysis suggest that polypharmacy remains widespread in US nursing homes. Although complex medication regimens are often necessary for nursing home residents, monitoring polypharmacy and its consequences may improve the quality of nursing home care and reduce unnecessary health care spending related to adverse events.
Self-reported prevalence and factors associated with nonadherence with glaucoma medications in veteran outpatients
2009, American Journal Geriatric Pharmacotherapy
Objective: The purpose of the current study was to determine the self-reported prevalence of and factors associated with nonadherence with glaucoma medications in veteran outpatients.
Methods: This survey study was conducted at a Veterans Affairs (VA) clinic. A survey was administered to patients with glaucoma. We calculated the percentage of self-reported adherence with glaucoma medications in each patient. Logistic regression was used to assess whether patient characteristics and difficulties with using glaucoma medications were related to patients' reporting that they were <100% adherent with their glaucoma medications in the previous week.
Results: The survey was completed by 141 patients (men, 91.5%; mean [SD] age, 70.22 [11.60] years [range, 37–93 years]; black race, 45.4%; white race, 44.0%; “other” or data unavailable, 10.6%). Nonwhite patients were significantly less adherent in the previous week than were white patients (27.0% vs 11.3%; P < 0.05). A total of 67.4% patients reported ≥1 difficulty in using their glaucoma medications. The 3 most commonly reported difficulties were “drops fall on cheek” (29.1%), “too many drops come out” (20.6%), and “hard to read print” (17.0%). A total of 19.1% of patients self-reported using <100% of their glaucoma medications in the previous week. The number of difficulties reported was significantly associated with reporting being <100% adherent in the previous week (P<0.05).
Conclusion: In this small sample of VA patients with glaucoma, adherence to glaucoma medications could be improved, especially among those who reported difficulties using their medications and those who were nonwhite.
Polypharmacy in elderly patients
2007, American Journal Geriatric Pharmacotherapy
Background: Polypharmacy (ie, the use of multiple medications and/or the administration of more medications than are clinically indicated, representing unnecessary drug use) is common among the elderly.
Objective: The goal of this research was to provide a description of observational studies examining the epidemiology of polypharmacy and to review randomized controlled studies that have been published in the past 2 decades designed to reduce polypharmacy in older adults.
Methods: Materials for this review were gathered from a search of the MEDLINE database (1986-June 2007) and International Pharmaceutical Abstracts (1986-June 2007) to identify articles in people aged >65 years. We used a combination of the following search terms: polypharmacy, multiple medications, polymedicine, elderly, geriatric, and aged. A manual search of the reference lists from identified articles and the authors' article files, book chapters, and recent reviews was conducted to identify additional articles. From these, the authors identified those studies that measured polypharmacy.
Results: The literature review found that polypharmacy continues to increase and is a known risk factor for important morbidity and mortality. There are few rigorously designed intervention studies that have been shown to reduce unnecessary polypharmacy in older adults. The literature review identified 5 articles, which are included here. All studies showed an improvement in polypharmacy.
Conclusions: Many studies have found that various numbers of medications are associated with negative health outcomes, but more research is needed to further delineate the consequences associated with unnecessary drug use in elderly patients. Health care professionals should be aware of the risks and fully evaluate all medications at each patient visit to prevent polypharmacy from occurring.
Racial and ethnic disparities in medication use among older adults
2006, American Journal Geriatric Pharmacotherapy

View all citing articles on Scopus

^☆: This study was performed with the support of AHCPR Grant No. R01-HS07819 and NIA Contract No. N01-AG-42102 in support of the Established Populations for Epidemiologic Studies of the Elderly (Duke).

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Original articleFactors predicting change in prescription and nonprescription drug use in a community-residing black and white elderly population☆

Abstract

J Clin Epidemiol

J Clin Epidemiol

Geriatric drug use and adverse drug event reporting in 1990: A descriptive analysis of two national data bases

Prescribed medicines: A summary of use and expenditures by Medicare beneficiaries

A 30 week randomized controlled trial of high dose tacrine in patients with Alzheimer's disease

JAMA

Longitudinella data och Kohortjämförelser frän en populationsundersökning

Läkartidningen

Changing patterns of psychotropic drug use in the elderly: A five year update

DICP

A longitudinal evaluation of drug use in an ambulatory elderly population

J Clin Epidemiol

Exploring dimensions of access to medical care

Health Serv Res

Prescription and non-prescription drug use among black and white community-residing elderly

Am J Public Health

Estimated prevalence of dementia among elderly black and white community residents

Arch Neurol

Medication use characteristics in the elderly: The Iowa 65 + Rural Hearth Study

J Am Geriatr Soc

Drug use patterns in black and nonblack community dwelling elderly

Ann Pharmacother

Assessing the use of medications in the elderly: Methods and initial experience in the cardiovascular health study

J Clin Epidemiol

A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients

J Am Geriatr Soc

A Guttman health scale for the aged

J Gerontol

Original article
Factors predicting change in prescription and nonprescription drug use in a community-residing black and white elderly population☆