Medication Regimens of Frail Older Adults After Discharge From Home Healthcare

Lancaster, Rachelle J.; Marek, Karen Dorman; Bub, Linda; Stetzer, Frank

doi:10.1097/nhh.0000000000000150

Cited by 10 publications

(6 citation statements)

References 31 publications

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“…These findings indicate the need for a multidisciplinary approach that coordinates medication use of older adults by providing physicians and pharmacists with the ability to view prescription histories online . In addition, findings from this study echo a recent study that suggested that ongoing home‐based multidisciplinary assessments and reconciliation activities are needed to prevent medication‐related complications . Finally, factors that contribute to underuse of pain medications by minority older adults with severe pain require immediate attention.…”

Section: Discussionsupporting

confidence: 65%

“…29 Additionally, findings from this study echo a recent study conducted by Lancaster and colleagues (2015) that suggests that home-based, multidisciplinary assessments and reconciliation activities on an ongoing basis are needed to prevent medication related complications. 30 Finally, factors that contribute to underutilization of pain medications among minority older adults with severe pain require immediate attention.…”

Section: Discussionmentioning

confidence: 99%

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Pain Treatment of Underserved Older African Americans

Yazdanshenas

Bazargan

Smith

et al. 2016

J American Geriatrics Society

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Older adult African Americans who experience pain are especially at high-risk for under assessment and treatment. This study examined the patterns and correlates of pain medication use that include the following: severity of pain, medical conditions, and access to care. Four hundred African American older adults aged 65 years and older were recruited from 16 churches located in South Los Angeles. Structured face-to-face interviews and visual inspection of each participant’s medications were conducted. More than 39% of participants were 75 years and older and 65% were female. Forty-seven percent used at least one type of pain medication. The frequency of pain medication use by pharmaceutical class was as follows: non-opioid (33%), opioid (12%), adjuvant (9%), and other drug (8%). Furthermore, 77% of non-opioids were Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and were used among 25%, 28%, 26%, and 28% of participants with hypertension, stroke, kidney disease, and gastrointestinal problems, respectively. Among participants who used NSAIDs, 98%, 69%, and 65% experienced Potentially Inappropriate Medication (PIM) use, drug duplication, and drug-drug interactions, correspondingly. This study suggests a severe mismanagement of pain among underserved African American older adults, particularly among individuals with co-morbidity, multiple providers, and limited access to health care. The use of pain medication was associated with drug-drug interactions, drug duplication, and PIM use. Our data shows that a large number of participants with severe pain are either not taking pain medication or experience PIM use. One out of four participants was taking NSAID pain relievers, which can cause serious side effects among aged African Americans with multiple chronic conditions.

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Section: Discussionsupporting

confidence: 65%

Section: Discussionmentioning

confidence: 99%

Pain Treatment of Underserved Older African Americans

Yazdanshenas

Bazargan

Smith

et al. 2016

J American Geriatrics Society

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“…Home-based, community-patient-centered, multidisciplinary approaches that connect local, community-based pharmacists with patients and their providers may be a promising approach. While a few researchers have suggested a multidisciplinary approach that coordinates medication use of older adults by providing both physicians and pharmacists with the ability to view online the prescription histories of patients [ 49 ], Lancaster and colleagues suggest that home-based, multidisciplinary assessments and reconciliation activities on an ongoing basis are needed to prevent medication related complications [ 50 ]. A Swedish study among older adults indicated that when reconciliation activities are mandated by law, the number of prescribed drugs and the extent of inappropriate drug therapy decreased significantly [ 51 ].…”

Section: Discussionmentioning

confidence: 99%

Polypharmacy among Underserved Older African American Adults

Bazargan

Smith

Movassaghi

et al. 2017

Journal of Aging Research

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The purpose of the present study was to examine correlates of polypharmacy among underserved community-dwelling older African American adults. Methods. This study recruited 400 underserved older African Americans adults living in South Los Angeles. The structured face-to-face interviews collected data on participants' characteristics and elicited data pertaining to the type, frequency, dosage, and indications of all medications used by participants. Results. Seventy-five and thirty percent of participants take at least five and ten medications per day, respectively. Thirty-eight percent of participants received prescription medications from at least three providers. Inappropriate drug use occurred among seventy percent of the participants. Multivariate analysis showed that number of providers was the strongest correlate of polypharmacy. Moreover, data show that gender, comorbidity, and potentially inappropriate medication use are other major correlates of polypharmacy. Conclusions. This study shows a high rate of polypharmacy and potentially inappropriate medication use among underserved older African American adults. We documented strong associations between polypharmacy and use of potentially inappropriate medications, comorbidities, and having multiple providers. Polypharmacy and potentially inappropriate medications may be attributed to poor coordination and management of medications among providers and pharmacists. There is an urgent need to develop innovative and effective strategies to reduce inappropriate polypharmacy and potentially inappropriate medication in underserved elderly minority populations.

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“…Prior research indicates that older adults with MCCs frequently have complex care needs and often experience transitions in care, which are frequently managed poorly 4 making them vulnerable for poor outcomes 5 including hospitalization, emergency department (ED) use, increased physician visits, 2 shorter time to death, 6 medication errors, 7,8 reduced quality of life 9 and decline in functional status. 10 Moreover, MCCs are contributing to this population’s higher rates of hospitalization and ED visits.…”

Section: Introductionmentioning

confidence: 99%

Identifying distinct risk profiles to predict adverse events among community-dwelling older adults

et al. 2017

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Preventing adverse events among chronically ill older adults living in the community is a national health priority. The purpose of this study was to generate distinct risk profiles and compare these profiles in time to: hospitalization, emergency department (ED) visit or death in 371 community-dwelling older adults enrolled in a Medicare demonstration project. Guided by the Behavioral Model of Health Service Use, a secondary analysis was conducted using Latent Class Analysis to generate the risk profiles with Kaplan Meier methodology and log rank statistics to compare risk profiles. The Vuong-Lo-Mendell-Rubin Likelihood Ratio Test demonstrated optimal fit for three risk profiles (High, Medium, and Low Risk). The High Risk profile had significantly shorter time to hospitalization, ED visit, and death (p < 0.001 for each). These findings provide a road map for generating risk profiles that could enable more effective targeting of interventions and be instrumental in reducing health care costs for subgroups of chronically ill community-dwelling older adults.

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Medication Regimens of Frail Older Adults After Discharge From Home Healthcare

Cited by 10 publications

References 31 publications

Pain Treatment of Underserved Older African Americans

Pain Treatment of Underserved Older African Americans

Polypharmacy among Underserved Older African American Adults

Identifying distinct risk profiles to predict adverse events among community-dwelling older adults

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