High-risk medication use among older adults with cognitive impairment living alone in the United States.

Autor: Growdon ME; Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA.; San Francisco VA Medical Center, San Francisco, California, USA., Jing B; Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA.; San Francisco VA Medical Center, San Francisco, California, USA., Yaffe K; San Francisco VA Medical Center, San Francisco, California, USA.; Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA.; Department of Psychiatry, University of California, San Francisco, California, USA.; Department of Neurology, Memory and Aging Center, University of California, San Francisco, California, USA.; The Global Brain Health Institute, University of California, San Francisco, California, USA., Karliner LS; Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, California, USA., Possin KL; Department of Neurology, Memory and Aging Center, University of California, San Francisco, California, USA.; The Global Brain Health Institute, University of California, San Francisco, California, USA., Portacolone E; Institute for Health & Aging, University of California, San Francisco, California, USA.; Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA., Boscardin WJ; Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA.; San Francisco VA Medical Center, San Francisco, California, USA.; Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA., Harrison KL; Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA.; The Global Brain Health Institute, University of California, San Francisco, California, USA.; Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA., Steinman MA; Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA.; San Francisco VA Medical Center, San Francisco, California, USA.
Jazyk: angličtina
Zdroj: Journal of the American Geriatrics Society [J Am Geriatr Soc] 2024 Jul 26. Date of Electronic Publication: 2024 Jul 26.
DOI: 10.1111/jgs.19108
Abstrakt: Background: More than one-fourth of older adults with cognitive impairment (CI) live alone; these individuals often lack support for medication management and face a high risk of adverse drug events. We characterized the frequency and types of high-risk medications used by older adults with CI living alone and, for context, compared patterns with those in older adults with CI living with others.
Methods: This was a cross-sectional study of National Health and Aging Trends Study (NHATS) data and Medicare claims (2015-2017). We ascertained cognitive status from NHATS and medication use with Part D claims. We compared high-risk medication use (those with adverse cognitive effects or low tolerance for misuse) among older adults with CI living alone versus living with others using logistic regression models adjusted for demographic/clinical factors.
Results: The unweighted sample included 1569 older adults with CI, of whom 491 (weighted national estimate, 31%) were living alone. In the living-alone group, the mean age was 79.9 years and 66% were female, 64% reported managing medications on their own without difficulty, 14% reported managing medications on their own with difficulty, and 18% received total support with medication management. Older adults with CI living alone used a median of 5 medications (IQR, 3-8), 16% took ≥10 medications, and 46% took ≥1 high-risk medication (anticholinergic/sedating: 24%; opioid: 13%; anticoagulant: 10%; sulfonylurea: 10%; insulin: 9%). Compared with those living with others, the use of high-risk medications was similar (p > 0.05 for unadjusted/adjusted comparisons). Those living alone were more likely both to take at least one high-risk medication and not receive help with medication management: 34% in those living alone versus 23% living with others (p < 0.05 for unadjusted/adjusted comparisons).
Conclusions: Older adults with CI living alone use many medications; nearly half use high-risk medications. Our findings can inform medication optimization interventions supporting this vulnerable population.
(© 2024 The American Geriatrics Society.)
Databáze: MEDLINE
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