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Researchers find potentially inappropriate drug use in nursing homes associated with deaths of elderly residents

Elderly nursing home residents given potentially inappropriate drugs intermittently over a 3-month period had an almost 90 percent greater likelihood of dying during the last month of that period than similar residents who were not administered the possibly inappropriate medications, according to a recent study conducted by researchers at the Agency for Healthcare Research and Quality.

Older people metabolize drugs differently than younger people, and they usually have a greater number of health problems than the general population. Thus, nursing home residents who usually are elderly, are of special concern, according to Denys T. Lau, Ph.D., formerly of AHRQ and now with the University of Michigan School of Public Health, and D.E.B. Potter, M.S., of AHRQ's Center for Financing, Access, and Cost Trends, and their colleagues.

In a separate analysis, the researchers found that over a 2-month period, residents who took potentially inappropriate medications during the last month of that period had a substantially higher chance of being hospitalized the following month than residents not exposed to the medications. The study is the first known analysis of the effects of potentially inappropriate medication prescribing in nursing homes based on nationally representative survey data. The researchers used the latest available data (1996) on nursing homes from AHRQ's Medical Expenditure Panel Survey Nursing Home Component (MEPS-NHC).

For more information, see "Hospitalization and death associated with potentially inappropriate medication prescriptions among elderly nursing home residents," by Dr. Lau, Judith D. Kasper, Ph.D., Ms. Potter, and others, in the January 2005 Archives of Internal Medicine 165, pp. 68-74.

Reprints (AHRQ Publication No. 05-R024) are available from the AHRQ Publications Clearinghouse.

In an earlier study, these AHRQ researchers found that, at a minimum, half of all people aged 65 and older who stayed in a nursing home for 3 months or longer in 1996 were given at least one potentially inappropriate medication. The most common drugs involved were propoxyphene (narcotic painkiller); amitriptyline (antidepressant); diphenhydramine and cyproheptadine (antihistamine with strong anticholinergic effects); hydroxyzine (anti-anxiety drug); oxybutynin (bladder muscle relaxant); ranitidine (antacid); and iron supplements.

The residents who were more likely to be given these drugs included those covered by Medicaid, individuals who were not high school graduates, and those who had mental disorders but not dementia. The study also found higher use of potentially inappropriate drugs in nursing homes with large numbers of beds and lower registered nurse-to-resident ratios.

Details are in "Potentially inappropriate medication prescriptions among elderly nursing home residents: Their scope and associated resident and facility characteristics," by Drs. Lau and Kasper, Ms. Potter, and Alan Lyles, Sc.D., in the October 2004 Health Services Research 39(5), pp. 1257-1276.

Reprints (AHRQ Publication No. 05-R022) are available from the AHRQ Publications Clearinghouse.

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