Hospitalization and death associated with potentially inappropriate medication prescriptions among elderly nursing home residents

BACKGROUND: This study examines the association of potentially inappropriate medication prescribing (PIRx) with hospitalization and death among elderly long-stay nursing home residents. METHODS: We defined PIRx using the combined version of the Beers criteria. Data were from the 1996 Medical Expenditure Panel Survey Nursing Home Component. The study sample included 3372 residents, 65 years and older, who had nursing home stays of 3 consecutive months or longer in 1996. We performed multivariate logistic regression analyses of longitudinal data using generalized estimating equations. RESULTS: Residents who received any PIRx had greater odds (odds ratio [OR], 1.27; P = .002) of being hospitalized in the following month than those receiving no PIRx. Residents with PIRx exposure for 2 consecutive months were at increased risk (OR, 1.27; P = .004) of hospitalization, as were those receiving PIRx in the second month only (OR, 1.80; P = .001), compared with those receiving no PIRx. Residents who received PIRx were at greater risk of death (OR, 1.28; P = .01) that month or the next. Residents with intermittent PIRx exposures were at greater odds of death (OR, 1.89; P<.001), compared with those with no PIRx exposure. CONCLUSIONS: The association of PIRx with subsequent adverse outcomes (hospitalization and death) provides new evidence of the importance of improving prescribing practices in the nursing home setting.     

Reliability of a medication adherence measure in an outpatient setting

BACKGROUND: Reliable approaches for measuring antihypertensive medication compliance in the outpatient setting are not readily available. The objective of the current study was to determine the reliability of the Hill-Bone Compliance Scale among elderly hypertensive patients. METHODS: We conducted a cross-sectional survey of community-dwelling patients attending the hypertension section of the Internal Medicine Clinic in a large multispecialty group practice. Participants (n=239) completed a self-administered questionnaire consisting of demographic questions and the Hill-Bone Compliance to High Blood Pressure Therapy Scale, which includes a nine-item medication compliance subscale. RESULTS: The mean age of respondents was 69 years; 51% of patients were men, 73% were white, 86% had at least a high school education, and 61% were married. The Cronbach alpha was 0.68 for the medication compliance subscale. All nine items of the medication compliance subscale maintained higher correlations with their own subscale total than with the salt intake and appointment keeping subscale totals. After adjusting for other demographic variables, the odds ratio (95% confidence interval) of perfect medication compliance as reported on the medication compliance subscale was 1.71 (0.95-3.07) for participants 65 years of age and older versus those younger than 65 years of age, 2.53 (1.37-4.66) for whites versus nonwhites, 1.27 (0.73-2.20) for males versus females, 1.30 (0.73-2.29) for married versus unmarried participants, and 1.63 (0.74-3.62) for those with at least a high school education versus those with less education. CONCLUSION: The medication compliance subscale of the Hill-Bone Compliance Scale appears reliable and may be a useful tool for detecting noncompliant patients in outpatient settings.     

Predictive validity of a medication adherence measure in an outpatient setting

This study examines the psychometric properties and tests the concurrent and predictive validity of a structured, self-reported medication adherence measure in patients with hypertension. The authors also assessed various psychosocial determinants of adherence, such as knowledge, social support, satisfaction with care, and complexity of the medical regimen. A total of 1367 patients participated in the study; mean age was 52.5 years, 40.8% were male, 76.5% were black, 50.8% graduated from high school, 26% were married, and 54.1% had income <$5,000. The 8-item medication adherence scale was reliable (alpha=.83) and significantly associated with blood pressure control (P<.05). Using a cutpoint of <6, the sensitivity of the measure to identify patients with poor blood pressure control was estimated to be 93%, and the specificity was 53%. The medication adherence measure proved to be reliable, with good concurrent and predictive validity in primarily low-income, minority patients with hypertension and might function as a screening tool in outpatient settings with other patient groups.     

Associations of potentially inappropriate medication use with four year survival of an inception cohort of nursing home residents

BackgroundSurvival in older adults has a high variability. The possible association of length of survival with potentially inappropriate medication (PIM) use remains unclear.AimTo examine the four-year survival rate, the prevalence of polypharmacy and PIM use at admission, and the association between the two, in an inception cohort of newly admitted nursing home residentsMethodsData were used from ageing@NH, a prospective observational cohort study in nursing homes. Residents (n = 613) were followed for four years after admission or until death. PIM use was measured at admission, using STOPPFrail. The Kaplan-Meier method was used to estimate survival, using log-rank tests for subgroup analyses. Cox regression analyses was used to explore associations with PIM use and polypharmacy, corrected for covariatesResultsMean age was 84, 65% were females. After one, two, three and four years the survival rates were respectively 79%, 60.5%, 47% and 36%. At admission, 47% had polypharmacy and 40% excessive polypharmacy, 11% did not use any PIMs, and respectively 28%, 29%, and 32% used one, two and three or more PIMs. No difference in survival was found between polypharmacy and no polypharmacy, and PIM use and no PIM use at admission. Neither polypharmacy nor PIM use at admission were associated with mortality.ConclusionResidents survived a relatively short time after NH admission. Polypharmacy and PIM use at admission were relatively high in this cohort, although neither was associated with mortality.     

Association of occupational activity with radiographic knee osteoarthritis and lumbar spondylosis in elderly patients of population‐based cohorts: A large‐scale population‐based study

Objective

To investigate the risk of radiographic knee osteoarthritis (OA) and lumbar spondylosis associated with occupational activity in elderly Japanese subjects using the large‐scale population‐based cohort of the Research on Osteoarthritis Against Disability (ROAD) study.

Methods

From the baseline survey of the ROAD study, 1,471 participants age ≥50 years (531 men and 940 women) living in mountainous and seacoast communities were analyzed. Information collected included a lifetime occupational history and details of specific work place physical activities. Radiographic severity at the knee and lumbar spine was determined by the Kellgren/Lawrence (K/L) grading system.

Results

The prevalence of K/L grade ≥2 knee OA and lumbar spondylosis among agricultural, forestry, and fishery workers was significantly higher than among clerical workers and technical experts in the overall population. For occupational activities, sitting on a chair had a significant inverse association with K/L grade ≥2 knee OA and lumbar spondylosis. Standing, walking, climbing, and heavy lifting were associated with K/L grade ≥2 knee OA, but were not associated with K/L grade ≥2 lumbar spondylosis. Kneeling and squatting were associated with K/L grade ≥3 knee OA.

Conclusion

This cross‐sectional study using a population‐based cohort suggests that sitting on a chair is a significant protective factor against both radiographic knee OA and lumbar spondylosis in Japanese subjects. An occupational activity that includes heavy lifting appears to have a greater effect on knee OA than on lumbar spondylosis.     

Retraction Statement: Predictive validity of a medication adherence measure in an outpatient setting

Morisky, D.E., Ang, A., Krousel-Wood, M. and Ward, H.J. (2008), Predictive Validity of a Medication Adherence Measure in an Outpatient Setting. The Journal of Clinical Hypertension, 10: 348–354. https://doi.org/10.1111/j.1751-7176.2008.07572.x . The above article, published online on May 02, 2008 on Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the journal's Editor-in-Chief, Dr. Ji-Guang Wang, and Wiley Periodicals LLC. Following publication, concerns were raised by a third party regarding the statistical analysis presented in the article. The Journal conducted an independent statistical review of the article and concluded that the results were misleading due to issues regarding the sensitivity and specificity of the medical adherence scale used. The authors responded to the Journal's request to address the findings of the independent statistical review, but were unable to adequately address the concerns. As a result, the Journal no longer has confidence in the reported conclusions and is issuing this retraction.