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Inappropriate medication use among the elderly is particularly high. In fact, nearly one-third of elderly home health care patients surveyed in a recent study were taking a drug considered inappropriate for older people or had some other evidence of a potential medication problem. Elderly home health care patients are frequent medication users, and advanced age and frailty may increase their susceptibility to adverse medication effects. Indeed, the Health Care Financing Administration (now the Centers for Medicare & Medicaid Services) requires that home health care agencies record all medications their patients are taking and conduct a drug regimen review.
Results of a survey by researchers at the Center for Education and Research in Therapeutics (CERT) at Vanderbilt University indicate that more effective methods are needed to improve medication use in this vulnerable group. The study was supported in part by the Agency for Healthcare Research and Quality (HS10384) and the John A. Hartford Foundation.
The researchers surveyed elderly (age 65 or older) home health care patients cared for by two of the largest urban home health care agencies in the United States between 1996 and 1998. They used two sets of expert panel criteria to define possible medication errors. The Home Health Criteria identified symptoms that indicate a problem with medication, such as uncontrolled hypertension despite antihypertensive use or recent falls or confusion while on psychotropic medications. The Beers criteria identify patterns of medication use that have been shown to be risky in the elderly, such as use of muscle relaxants and short-acting benzodiazepines, which are used to treat anxiety and insomnia.
The 6,718 patients studied took a median of five drugs, with 19 percent of them taking nine or more medications. Based on Home Health Criteria, 19 percent of patients had possible medication errors; based on Beers criteria, 17 percent did; 30 percent had possible medication errors based on both Home Health and Beers criteria. Ten percent of those taking one to three medications had possible errors, compared with 32 percent of those taking nine or more drugs based on Home Health Criteria, 8 percent and 32 percent, respectively, based on Beers criteria, and 16 percent and 50 percent, respectively, based on both criteria.
See "Possible medication errors in home healthcare patients," by Sarah Meredith, M.B.B.S., M.Sc., Penny H. Feldman, Ph.D., Dennee Frey, Pharm.D., and others, in the June 2001 Journal of the American Geriatrics Society 49, pp. 719-724.
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