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

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

4. 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. 5 2004 National Nursing Home Survey  Survey items medications taken 24 hrs before facility interview 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 medications taken regularly but not 24 hrs before facility interview  up to 25 medications reason medications were prescribed reason medications were prescribed

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

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

8. 8 2004 National Nursing Home Survey  Results: 1.3 million elderly current residents 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 Preliminary Results. *Statistically significant difference, p < 0.01

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

10. 10 Therapeutic Class % of residents (n=1,315,597) % ther. classes (n=11,528,485) Vitamins or minerals 56.56.5 Laxatives48.35.5 Antidepressants46.35.3 Non-narcotic analgesics 45.85.2 Antipyretics43.55.0 Acid or peptic disorders 42.64.9 Diuretics36.84.2 Antiarthritics32.53.7 Replenishers/regulators of electrolytes 31.53.6 Antipsychotics or antimanics 24.82.8 Top Therapeutic Classes Taken by Elderly Residents Preliminary Results.

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

12. 12 2004 National Nursing Home Survey  Summary Preliminary analysis reveals that many residents took > 9 medications. Preliminary analysis reveals that many residents took > 9 medications. Metabolic/nutrients, pain relievers, gastrointestinal agents, and CNS drugs were taken frequently. 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. 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. Preliminary Results.

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

14. 14 2006 NCHS Data Users Conference