Examination of Multiple Medication Use Among TRICARE Beneficiaries Aged 65 Years and Older

Abstract

he simultaneous use of multiple prescription medications has been repeatedly identified as an area of concern, particularly among our nation' s older adults.1 While older adults typically require more medications to manage multiple comorbidities, disease-centric prescribing, reduced organ function, and higher use of over-the-counter products among older adults complicates a prescriber' s or pharmacist' s ability to anticipate how concomitant use of multiple medications is likely to affect the underlying mechanisms by which each functions as prescribed.2,3 While risks associated with use of specific medications or combinations of medications among older patients have been well characterized, 4-6 assimilation of this information into prescribing practice is not evident. Perhaps many prescribers simply cannot consider all the medications their patients are already taking when they prescribe a new medication. 7 The likelihood of patients becoming confused by or noncompliant with their own drug regimen also increases with the size of their medication list.2 Too often, a critical review of a patient' s medication use is not conducted until after an adverse drug event occurs and has been recognized as such. 8Many of the studies examining multiple medication use by older adults to date have focused on non-U.S. populations, whereas studies on U.S. populations have focused more on inappropriate prescribing and medication-specific risks. Among the available literature, there is general agreement that multiple prescription medication use is more prevalent among older adults, women, and cardiovascular patients, but estimates vary widely and comparison of findings is complicated by the absence of a standard time period over which medication use ABSTRACT BACKGROUND: The simultaneous use of multiple prescription medications has been associated with an increased risk of adverse drug events and other drug-related complications, especially in the elderly.OBJECTIVE: To quantify the prevalence of use of multiple medications among a sample of Department of Defense (DoD) health care beneficiaries, aged 65 years and older, who used their TRICARE (military health care services) benefit to obtain prescription medication.METHODS: Outpatient pharmacy fill records were analyzed for a 10% random sample of 1.27 million TRICARE beneficiaries aged 65 years and older who obtained 1 or more prescription medications in the 90-day period from (P <0.001). The prevalence of multiple drug use peaked among beneficiaries aged 80 to 84 years. Cardiovascular drugs, central nervous system agents, and hormones and synthetic substitutes were the 3 most common therapeutic categories used by 77%, 48%, and 42% of beneficiaries, respectively.CONCLUSION: This baseline analysis documented the common use of multiple medications among TRICARE beneficiaries. The DoD faces a challenge similar to that of Medicare Part D drug plans to cost-effectively monitor and optimize pharmacotherapy for its older beneficiaries.

Drug utilization and polypharmacy in an Italian elderly population: the EPIFARM‐elderly project

“…Cardiovascular, central nervous system, and alimentary tract drugs were the top three medication classes most often prescribed for the elderly in previous studies 11–18, 33. Our study gave similar results except for central nervous system drugs.…”

“…The aging of the population and the resulting increase of multiple chronic diseases have led to rising drug prescription 1–7. Although many studies have also recently described the high use of medications in community‐dwelling elderly people,8–13 only few have analyzed the associations of chronic medications and number of drug prescriptions with age and sex 14–17…”

“…Other studies have reported user rates from 65% to 96% among older people, a broad interval that may be due to differing inclusion criteria or how medication data is collected 15, 18–21. With regard to sex, women have been reported to use more drugs than men,8, 16, 17 and increasing age has been associated to the number of prescribed drugs 8, 11, 12, 16, 17, 19. A recent study found that female sex (odds ratio [OR] 2.43; 95%CI 1.27–4.65) and age ≥85 years (OR 2.84; 95%CI 1.08–3.89) were among factors associated with the use of 10 or more drugs 8…”

Prevalence of Beers Criteria Medications Among Elderly Patients in a Military Hospital

“…As civilian and government hospitals do not have combined medical records, it is difficult for the DoD to properly manage medications. In one study of 123,682 TRICARE beneficiaries 65 years and older, 50% obtained six or more medications, and 3% obtained 16 or more medications from the pharmacy during a 90-day period (Linton, Garber, Fagan, & Peterson, 2007). …”

Factors Associated With Choice of Pharmacy Setting Among DoD Health Care Beneficiaries Aged 65 Years or Older

“…A prior study on the age 65+ TRICARE beneficiary population found that maintenance medications dominated the medication lists of TRICARE beneficiaries, and treatments for cardiovascular disease, high blood pressure, diabetes, and arthritis topped the list of most commonly used medications. 18 These beneficiaries represent the ideal target population for DoD' s migration initiative for the transfer of prescription fills from community and military pharmacies to TMOP.…”