Medication Practices for the Elderly in U.S. Nursing Homes

1. Medication Practices for the Elderly in U.S. Nursing Homes Lisa L. Dwyer, MPH Robin E. Remsburg, PhD, APRN, BC Division of Health Care Statistics National Center for Health Statistics AcademyHealth Annual Research Meeting 2006: Seattle, WA June 26, 2006

2. Introduction • Previous study reports that medication use is highest among the institutionalized elderly. • comorbidities • pharmacodynamics and pharmacokinetics • inappropriate medications • Greater potential for adverse events

3. Introduction Current estimates of the number and types of medications taken by the nursing home elderly are lacking.

4. Research Questions • What was the average number of medications taken by elderly nursing home residents? • What were the most frequent therapeutic classes taken by these residents? • What percentage of residents took benzodiazepines and barbiturates before the Medicare Part D implementation?

5. 2004 National Nursing Home Survey • Survey items • medications taken 24 hrs before facility interview • standing or routine medications, or PRNs • up to 25 medications • medications taken regularly but not 24 hrs before facility interview • up to 25 medications • reason medications were prescribed

6. 2004 National Nursing Home Survey • Medication data • found in medication administration records • did not collect dosage, frequency, route • provided by respondent during facility interview • entered into CAPI system by interviewer • were appended with drug characteristics

7. 2004 National Nursing Home Survey • Drug characteristics appended • generic name • ingredients • therapeutic classes • composition status • prescription status • DEA status

8. Preliminary Results. 2004 National Nursing Home Survey • Results: • 1.3 million elderly current residents • 26% male, 74% female • mean age = 85 y.o. (standard error = 0.11) • male = 82 y.o. (S.E. = 0.19)*, female = 86 y.o. (S.E. = 0.11)* • 87% white, 11% black, 2% other *Statistically significant difference, p < 0.01

9. Preliminary Results. 2004 National Nursing Home Survey • Mean number of medications • Overall = 8.7 Rxs • male = 8.5 Rxs* • female = 8.8 Rxs* • 41% of elderly residents took more than 9 Rxs. Statistically significant difference, p<0.05

10. Preliminary Results. Top Therapeutic Classes Taken by Elderly Residents

11. Preliminary Results. 2004 National Nursing Home Survey • Medicare Part D exclusions include: • barbiturates < 1% of residents • benzodiazepines = 13% of residents • prescription vitamin/minerals • nonprescription drugs

12. Preliminary Results. 2004 National Nursing Home Survey • Summary • Preliminary analysis reveals that many residents took > 9 medications. • Metabolic/nutrients, pain relievers, gastrointestinal agents, and CNS drugs were taken frequently. • Residents who took benzodiazepines (13%) may be affected by the Medicare Part D exclusions; residents who took prescription vitamins/minerals and nonprescription products may be affected as well.

13. Preliminary Results. 2004 National Nursing Home Survey • Significance/relevance • Patient safety • Evaluation of Medicare Part D implementation • health outcomes of residents • change(s) in clinical practice • policy makers’ response

14. 2006 NCHS Data Users Conference