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2012 Nordic Conference on Gerontology (NKG)

2012 Nordic Conference on Gerontology (NKG). Medical Emergencies: A Strategy to Assess and Identify Potentially Inappropriate Medications (PIMs) for Older Persons. Victoria A. Albright Al Woodward Victoria Scott June 12, 2012. Drug Abuse Warning Network (DAWN)

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2012 Nordic Conference on Gerontology (NKG)

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  1. 2012 Nordic Conference on Gerontology (NKG) Medical Emergencies: A Strategy to Assess and Identify Potentially Inappropriate Medications (PIMs) for Older Persons Victoria A. AlbrightAl WoodwardVictoria Scott June 12, 2012

  2. Drug Abuse Warning Network (DAWN) • Center for Behavioral Health Statistics and Quality (CBHSQ), Substance Abuse and Mental Health Services Administration (SAMHSA) • Screen sample of emergency department (ED) visit records • Collect data on ED visits related to drugs • Inclusion criteria • Adverse reactions, overmedication, pharmaceutical misuse, accidental ingestion, suicide attempts • Just under 5 million+ drug-related visits in 2010; about three-quarters of a million by persons aged 65 and older 2

  3. Introduction • Older persons (65+) need to take special care in choosing medications • Potentially inappropriate medications (PIMs) – a balance of risks and benefits • How DAWN data can help evaluate use of PIMs • What you will know at the end • Considerations before viewing findings 3

  4. ED visits for unintentional injuries by older persons SOURCE: Center for Behavioral Health Statistics and Quality, SAMHSA, Drug Abuse Warning Network, 2010. 4

  5. Trends in drug-related ED visits for older persons SOURCE: Center for Behavioral Health Statistics and Quality, SAMHSA, Drug Abuse Warning Network, 2010. 5

  6. Characteristics of drug-related ED visits for older persons – follow-up SOURCE: Center for Behavioral Health Statistics and Quality, SAMHSA, Drug Abuse Warning Network, 2010. 6

  7. Characteristics of drug-related ED visits for older persons – # of drugs involved SOURCE: Center for Behavioral Health Statistics and Quality, SAMHSA, Drug Abuse Warning Network, 2010. 7

  8. Characteristics of drug-related ED visits for older persons – sex of patient SOURCE: Center for Behavioral Health Statistics and Quality, SAMHSA, Drug Abuse Warning Network, 2010. 8

  9. Drugs involved in drug-related ED visits for older persons SOURCE: Center for Behavioral Health Statistics and Quality, SAMHSA, Drug Abuse Warning Network, 2010. 9

  10. Grading PIMs • A – PIM below level of detection (*) • B – PIM is measurable but not increasing • C – Non-PIM is measurable but not increasing • D – PIM is measurable and increasing • F – Non-PIM is measurable and increasing 10

  11. A – Below level of detection (*) SOURCE: Center for Behavioral Health Statistics and Quality, SAMHSA, Drug Abuse Warning Network, 2010. 11

  12. B – PIMs are measurable but not increasing (NC) SOURCE: Center for Behavioral Health Statistics and Quality, SAMHSA, Drug Abuse Warning Network, 2010. 12

  13. B – PIMs are measurable but not increasing (2) SOURCE: Center for Behavioral Health Statistics and Quality, SAMHSA, Drug Abuse Warning Network, 2010. 13

  14. C - Non-PIMs are measurable but not increasing (1) SOURCE: Center for Behavioral Health Statistics and Quality, SAMHSA, Drug Abuse Warning Network, 2010. 14

  15. C - Non-PIMs are measurable but not increasing (2) SOURCE: Center for Behavioral Health Statistics and Quality, SAMHSA, Drug Abuse Warning Network, 2010. 15

  16. D - PIMs are measurable and some increasing (1) 16 SOURCE: Center for Behavioral Health Statistics and Quality, SAMHSA, Drug Abuse Warning Network, 2010.

  17. D - PIMs are measurable and some increasing (2) SOURCE: Center for Behavioral Health Statistics and Quality, SAMHSA, Drug Abuse Warning Network, 2010. 17

  18. D - PIMs are measurable and some increasing (3) SOURCE: Center for Behavioral Health Statistics and Quality, SAMHSA, Drug Abuse Warning Network, 2010. 18

  19. Benzodiazepine PIMs SOURCE: Center for Behavioral Health Statistics and Quality, SAMHSA, Drug Abuse Warning Network, 2010. 19

  20. D - PIMs are measurable and increasing (4) SOURCE: Center for Behavioral Health Statistics and Quality, SAMHSA, Drug Abuse Warning Network, 2010. 20

  21. D - PIMs are measurable and increasing (5) SOURCE: Center for Behavioral Health Statistics and Quality, SAMHSA, Drug Abuse Warning Network, 2010. 21

  22. F – Non-PIMs are measurable and increasing (1) SOURCE: Center for Behavioral Health Statistics and Quality, SAMHSA, Drug Abuse Warning Network, 2010. 22

  23. F – Non-PIMs are measurable and increasing (2) SOURCE: Center for Behavioral Health Statistics and Quality, SAMHSA, Drug Abuse Warning Network, 2010. 23

  24. F – Non-PIMs are measurable and increasing (3) SOURCE: Center for Behavioral Health Statistics and Quality, SAMHSA, Drug Abuse Warning Network, 2010. 24

  25. Non-narcotic pain reliever rates SOURCE: Center for Behavioral Health Statistics and Quality, SAMHSA, Drug Abuse Warning Network, 2010. 25

  26. Summary of A, B, C, D, and F Grade Drugs • A – 134 PIMs • B – 24 PIMs • C – 7 PIMs • D – 9 PIMs • F – 4 PIMs 26

  27. Any other drugs we should think about? • High rates of involvement or high increases SOURCE: Center for Behavioral Health Statistics and Quality, SAMHSA, Drug Abuse Warning Network, 2010. 27

  28. Any more? SOURCE: Center for Behavioral Health Statistics and Quality, SAMHSA, Drug Abuse Warning Network, 2010. 28

  29. And more? SOURCE: Center for Behavioral Health Statistics and Quality, SAMHSA, Drug Abuse Warning Network, 2010. 29

  30. Findings and Conclusions Beers Criteria Drugs • Many Beers Criteria drugs have fallen below level of detection • N = 134 • Some have stabilized with no change 2005–2010 • N = 24 • May reflect “acceptable risk” • Some have increasing involvement 2005–2010 • N = 9 • May suggest need for additional messaging to medical community, research to develop alternative treatments 30

  31. Findings and Conclusions continued Non-Beers Criteria Drugs • Some appear in same therapeutic categories as PIMs but involvement is not increasing • N = 7 • May suggest need for further investigation to determine if these are of particular risk to older persons • Some appear in same therapeutic categories as PIMs and involvement is increasing • N = 4 • May suggest that serious consideration is needed to determine if these drugs should be added to Beers Criteria • Some are non-prescription • For example, nutritional product • May suggest need for increased public health messaging to older persons 31

  32. Findings and Conclusions continued Non-Beers Criteria Drugs continued • Some just appear at very high levels for older persons and involvement is increasing • May suggest need for further investigation for alternative treatments, increased messaging to medical community, and consideration for inclusion as Beers Criteria drug 32

  33. Next Steps • Combine data across years to investigate differences by drug combinations, sex and age (i.e., younger older persons versus older older persons) • Add information on prescribing levels to the analysis to better assess potential for adverse reactions and misuse • Evaluate prescribing strategies to see if there are relationships between PIMs in different therapeutic groups. That is, is decreasing PIM involvement in one therapeutic group being offset by increases in a different group? • Determine if any changes in the health of the older population might explain increases in PIMs, e.g., has rise in diabetes caused rise in visits involving insulin and biguanides? 33

  34. For further information DAWN: www.samhsa.gov/data/DAWN.aspx SAMHSA: www.samhsa.gov RTI: www.rti.org Presenting Author: Victoria A. Albright RTI International 919 541 6805 valbright@RTI.org 34

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