Health Care Industry
Industry: Email Alert RSS FeedPotentially inappropriate medication prescriptions among elderly nursing home residents: their scope and associated resident and facility characteristics
Health Services Research, Oct, 2004 by Denys T. Lau, Judith D. Kasper, D.E.B. Potter, Alan Lyles
Table 1: Patterns of Potentially Inappropriate Medication Prescriptions
(PIRx) among Residents, Aged 65 and Older, with a Nursing Home Stay of
Three Consecutive Months or Longer in 1996. ([section])
Patterns of PIRx % of Residents (S.E.)
Number of PIRx ([paragraph])
Zero (no PIRx) 49.7 (1.04)
At least one 50.3 (1.04)
One 28.1 (0.89)
Two 13.3 (0.73)
Three 5.3 (0.40)
Four or more 3.6 (0.33)
Type of PIRx (#)
Inappropriate drug choice 40.4 (1.04)
Excess dosage 11.4 (0.61)
Drug-disease interaction 12.8 (0.64)
PIRx with the potential for severe harm 17.3 (0.81)
([section]) 51% of all nursing home users in 1996 (n = 3,372).
Percentages based on weighted data and available prescribed medicine
data.
([paragraph]) Number of PIRx indicates the number of different drugs
names that matched Beers's criteria received during the year and not
the frequency of use.
(#) Residents can have multiple types of PIRx exposures during the
year.
Source: Center for Cost and Financing Studies, Agency for Healthcare
Research and Quality, The 1996 Medical Expenditure Panel Survey Nursing
Home Component.
Table 2: Characteristics of Nursing Home Residents and Multivariate
Logistic Regression Analysis of Resident and Resident/Facility
Characteristics Associated with Having Potentially Inappropriate
Medication Prescriptions (PIRx). ([section])
Resident
Model
% of Odds 95%
Characteristics Residents Ratio C.I.
Resident Characteristics
Age
65-74 14.6 1.00 (0.81, 1.34)
75-84 35.8 1.04 (0.74, 1.06)
85 and older 49.6 0.89 (1.00, 1.00)
Sex
Male 26.2 1.16 (0.96, 1.40)
Female 73.8 1.00 (1.00, 1.00)
Race
Black 8.1 0.79 (0.60, 1.05)
White/Hispanics/ 91.9 1.00 (1.00, 1.00)
others
Marital status
Married 17.9 1.10 (0.87, 1.38)
Not married 82.1 1.00 (1.00, 1.00)
Living children
Yes 70.6 1.02 (0.86, 1.22)
No 29.4 1.00 (1.00, 1.00)
Education level
No high school degree 54.6 1.02 (0.85, 1.22)
With high school 45.4 1.00 (1.00, 1.00)
degree
Poverty level
Less than poverty 26.2 1.06 (0.71, 1.57)
100 to <200 percent 45.6 0.88 (0.61, 1.27)
200 to <400 percent 20.9 0.89 (0.60, 1.31)
400 percent or more 7.3 1.00 (1.00, 1.00)
Medicaid coverage
Yes 71.3 1.39 (1.10, 1.75) *
No 28.7 1.00 (1.00, 1.00)
Admission before 1996
Yes 77.5 1.06 (0.82, 1.39)
No 22.5 1.00 (1.00, 1.00)
Nursing home days in 1996
90 to 120 days 4.9 0.87 (0.56, 1.34)
121 to 200 days 11.4 0.87 (0.64, 1.17)
201 to 280 days 11.6 1.04 (0.75, 1.43)
281 to 366 days 72.1 1.00 (1.00, 1.00)
Mental status
Alzheimer's disease 47.7 0.88 (0.72, 1.06)
and other dementia
Other mental 15.1 1.35 (1.04, 1.76) *
disorders only
No mental disorder 37.2 1.00 (1.00, 1.00)
Number of activities-of-
daily-living limitations
0 to 3 23.5 1.05 (0.84, 1.32)
4 to 5 30.3 1.14 (0.99, 1.40) ([yen])
6 46.2 1.00 (1.00, 1.00)
Behavior problems
Yes 27.7 1.16 (0.98, 1.39) ([yen])
No 72.3 1.00 (1.00, 1.00)
Communication problems
Yes 29.7 0.66 (0.55, 0.80) **
No 70.3 1.00 (1.00, 1.00)
Average number of drugs
per month
Less than 5 31.6 0.25 (0.19, 0.31) **
5 to <9 44.4 0.49 (0.39, 0.62) **
9 or more 24.0 1.00 (1.00, 1.00)
Facility Characteristics
Ownership
For-profit 64.6
Nonprofit/Public 35.4
Type
Hospital-based 7.0
With multiple 12.6
levels of care
With only NH beds 80.4
Certification status
Not federally 3.3
certified
Either Medicare 16.2
only or Medicaid
only
Medicare and 80.5
Medicaid
Accreditation status
Yes 16.6
No 83.4
Number of beds
3 to 49 6.0
50 to 99 25.1
100 to 149 33.9
150 to 199 15.7
200 or more 19.3
Registered nurse (RN)-to-
non-RN ratio
Fewer than 1 : 10 32.6
Between 1 : 10 and 38.5
1 : 5
Greater than 1 : 5 28.9
Registered nurse
(RN)-to-resident ratio
Fewer than 1 : 20 26.0
Between 1 : 20 and 42.8
1 : 10
Greater than 1 : 10 31.2
Pharmacist onsite once
a week
Yes 46.2
No 53.8
Psychologist or
psychiatrist onsite
once a week
Yes 41.3
No 58.7
Selected technological
services offered
([paragraph])
3 or 4 services 13.7
2 services 44.4
1 service 32.5
None 9.4
Influenza vaccination
percentage
90 percent and 51.5
higher
75 percent to < 90 27.4
percent
Less than 75 21.1
percent
Census region
Northeast 23.4
Midwest 31.8
South 32.8
West 12.0
Metropolitan statistical
area
Yes 70.1
No 29.9
Nursing home beds
available (#)
5 and fewer 15.2
> 5 to 10 25.5
> 10 to 15 22.9
> 15 to 20 12.5
More than 20 23.9
County-level income
per capita (in $1,000s)
Less than or equal 30.2
20
> 20 to 25 34.8
> 25 to 30 23.5
More than 30 11.5
Facility
Model
Odds 95%
Characteristics Ratio C.I.
Resident Characteristics
Age
65-74
75-84
85 and older
Sex
Male
Female
Race
Black
White/Hispanics/
others
Marital status
Married
Not married
Living children
Yes
No
Education level
No high school degree
With high school
degree
Poverty level
Less than poverty
100 to <200 percent
200 to <400 percent
400 percent or more
Medicaid coverage
Yes
No
Admission before 1996
Yes
No
Nursing home days in 1996
90 to 120 days
121 to 200 days
201 to 280 days
281 to 366 days
Mental status
Alzheimer's disease
and other dementia
Other mental
disorders only
No mental disorder
Number of activities-of-
daily-living limitations
0 to 3
4 to 5
6
Behavior problems
Yes
No
Communication problems
Yes
No
Average number of drugs
per month
Less than 5
5 to <9
9 or more
Facility Characteristics
Ownership
For-profit 1.04 (0.86, 1.25)
Nonprofit/Public 1.00 (1.00, 1.00)
Type
Hospital-based 0.86 (0.55, 1.35)
With multiple 0.94 (0.75, 1.19)
levels of care
With only NH beds 1.00 (1.00, 1.00)
Certification status
Not federally 2.54 (0.34, 18.89)
certified
Either Medicare 0.88 (0.69, 1.14)
only or Medicaid
only
Medicare and 1.00 (1.00, 1.00)
Medicaid
Accreditation status
Yes 0.78 (0.61, 0.99) *
No 1.00 (1.00, 1.00)
Number of beds
3 to 49 0.66 (0.41, 1.05) ([yen])
50 to 99 0.88 (0.68, 1.13)
100 to 149 0.93 (0.73, 1.18)
150 to 199 1.03 (0.78, 1.37)
200 or more 1.00 (1.00, 1.00)
Registered nurse (RN)-to-
non-RN ratio
Fewer than 1 : 10
Between 1 : 10 and
1 : 5
Greater than 1 : 5
Registered nurse
(RN)-to-resident ratio
Fewer than 1 : 20 1.37 (1.06, 1.75) *
Between 1 : 20 and 1.09 (0.90, 1.31)
1 : 10
Greater than 1 : 10 1.00 (1.00, 1.00)
Pharmacist onsite once
a week
Yes 0.96 (0.81, 1.14)
No 1.00 (1.00, 1.00)
Psychologist or
psychiatrist onsite
once a week
Yes 0.97 (0.81, 1.15)
No 1.00 (1.00, 1.00)
Selected technological
services offered
([paragraph])
3 or 4 services 0.95 (0.72, 1.25)
2 services 1.08 (0.81, 1.44)
1 service 0.95 (0.67, 1.34)
None 1.00 (1.00, 1.00)
Influenza vaccination
percentage
90 percent and 1.19 (0.97, 1.46)
higher
75 percent to < 90 1.18 (0.95, 1.48)
percent
Less than 75 1.00 (1.00, 1.00)
percent
Census region
Northeast 1.20 (0.88, 1.63)
Midwest 1.23 (0.92, 1.64)
South 1.18 (0.88, 1.57)
West 1.00 (1.00, 1.00)
Metropolitan statistical
area
Yes 0.77 (0.62, 0.96) *
No 1.00 (1.00, 1.00)
Nursing home beds
available (#)
5 and fewer 0.85 (0.65, 1.11)
> 5 to 10 1.03 (0.81, 1.32)
> 10 to 15 1.05 (0.83, 1.33)
> 15 to 20 1.06 (0.81, 1.38)
More than 20 1.00 (1.00, 1.00)
County-level income
per capita (in $1,000s)
Less than or equal 1.27 (0.90, 1.80)
20
> 20 to 25 1.33 (0.98, 1.79) ([yen])
> 25 to 30 1.51 (1.11, 2.05) *
More than 30 1.00 (1.00, 1.00)
Resident/
facility Model
Odds 95%
Characteristics Ratio C.I.
Resident Characteristics
Age
65-74 1.07 (0.83, 1.38)
75-84 0.93 (0.78, 1.11)
85 and older 1.00 (1.00, 1.00)
Sex
Male 1.14 (0.95, 1.37)
Female 1.00 (1.00, 1.00)
Race
Black 0.78 (0.59, 1.04) ([yen])
White/Hispanics/ 1.00 (1.00, 1.00)
others
Marital status
Married
Not married
Living children
Yes
No
Education level
No high school degree
With high school
degree
Poverty level
Less than poverty
100 to <200 percent
200 to <400 percent
400 percent or more
Medicaid coverage
Yes 1.31 (1.09, 1.59) *
No 1.00 (1.00, 1.00)
Admission before 1996
Yes 0.99 (0.79, 1.24)
No 1.00 (1.00, 1.00)
Nursing home days in 1996
90 to 120 days 0.84 (0.56, 1.25)
121 to 200 days 0.86 (0.65, 1.13)
201 to 280 days 0.98 (0.74, 1.31)
281 to 366 days 1.00 (1.00, 1.00)
Mental status
Alzheimer's disease 0.86 (0.71, 1.03)
and other dementia
Other mental 1.40 (1.07, 1.82) *
disorders only
No mental disorder 1.00 (1.00, 1.00)
Number of activities-of-
daily-living limitations
0 to 3 1.07 (0.85, 1.35)
4 to 5 1.23 (1.01, 1.49) *
6 1.00 (1.00, 1.00)
Behavior problems
Yes 1.17 (0.98, 1.41) ([yen])
No 1.00 (1.00, 1.00)
Communication problems
Yes 0.69 (0.57, 0.84) **
No 1.00 (1.00, 1.00)
Average number of drugs
per month
Less than 5 0.23 (0.19, 0.29) **
5 to <9 0.46 (0.37, 0.56) **
9 or more 1.00 (1.00, 1.00)
Facility Characteristics
Ownership
For-profit
Nonprofit/Public
Type
Hospital-based
With multiple
levels of care
With only NH beds
Certification status
Not federally
certified
Either Medicare
only or Medicaid
only
Medicare and
Medicaid
Accreditation status
Yes 0.70 (0.54, 0.92) *
No 1.00 (1.00, 1.00)
Number of beds
3 to 49 0.55 (0.34, 0.90) *
50 to 99 0.80 (0.62, 1.03) ([yen])
100 to 149 0.92 (0.73, 1.17)
150 to 199 0.99 (0.74, 1.31)
200 or more 1.00 (1.00, 1.00)
Registered nurse (RN)-to-
non-RN ratio
Fewer than 1 : 10
Between 1 : 10 and
1 : 5
Greater than 1 : 5
Registered nurse
(RN)-to-resident ratio
Fewer than 1 : 20 1.41 (1.11, 1.78) *
Between 1 : 20 and 1.11 (0.92, 1.35)
1 : 10
Greater than 1 : 10 1.00 (1.00, 1.00)
Pharmacist onsite once
a week
Yes
No
Psychologist or
psychiatrist onsite
once a week
Yes
No
Selected technological
services offered
([paragraph])
3 or 4 services
2 services
1 service
None
Influenza vaccination
percentage
90 percent and
higher
75 percent to < 90
percent
Less than 75
percent
Census region
Northeast
Midwest
South
West
Metropolitan statistical
area
Yes 0.81 (0.65, 1.01) ([yen])
No 1.00 (1.00, 1.00)
Nursing home beds
available (#)
5 and fewer
> 5 to 10
> 10 to 15
> 15 to 20
More than 20
County-level income
per capita (in $1,000s)
Less than or equal 1.31 (0.91, 1.87)
20
> 20 to 25 1.35 (0.99, 1.85) ([yen])
> 25 to 30 1.49 (1.09, 2.05) *
More than 30 1.00 (1.00, 1.00)
([section]) 51% of all nursing home users in 1996 (n = 3,372).
Percentages based on weighted data.
([paragraph]) Services include ventilator care, intravenous therapy,
dialysis, and tube feeding.
(#) Nursing home beds available is the number of empty beds/1,000
elderly (75 age).
([yen]) p < 0.100;
* p < 0.050;
** p < 0.001.
Source: Center for Cost and Financing Studies, Agency for Healthcare
Research and Quality, The National 1996 Medical Expenditure Panel
Survey Nursing Home Component.
Most RecentHealth Care Articles
Brought to you by CBS MoneyWatch.com
- Best- and Worst-Paid College Degrees
- 6 Things You Should Never Do on Twitter or Facebook
- How Much Sleep Do You Really Need?
- 6 Big Myths about Gas Mileage
- 5 Rules for Immediate Annuities
- Death in the Family: 12 Things to Do Now
- Dumbest Things You Do With Your Money
- 6 Online Networking Mistakes to Avoid
- 401(k) Mistakes to Avoid
- 5 Economic Scenarios to Keep You Up at Night
- The Real ‘Best Places to Retire’
- Best Credit Cards for You
- 12 Tough Questions to Ask Your Parents
- The Real ‘Best Colleges’
- Home Buyer Tax Credit: How to Cash In
- Why You Shouldn't Bash Cash
- 8 Phony 'Bargains' and Better Alternatives
- Danger: 3 Debit Card Scams to Avoid
- 6 Myths About Gas Mileage
- 29 Fees We Hate Most
- Quick and Easy Ways to Boost Returns
- Best Stocks to Buy Now
- Lower Your Taxes: 10 Moves to Make Now
- New Jobs: 8 Lessons from Real-Life Career Switchers
- The New Job Market: Who Wins and Who Loses?
- Health Care Reform's Public Option: Everything You Need to Know
- Volunteer Work When Unemployed: Should You Work for Free?
- Whose Recovery Is This?
- Long-Term-Care Insurance: 4 Biggest Risks to Avoid
Content provided in partnership with
Most Recent Health Articles
Most Recent Health Publications
Most Popular Health Articles
- Make running easier: with this unique 'pose running' technique, you'll learn to actually enjoy your fat-burning sessions
- 50 home remedies that work: these safe, fast, and effective fixes will relieve what ails you - Cover Story
- Detox in 7 days: a detoux diet can help you shed up to 10 pounds and leave you feeling terrific. Our weeklong plan shows you how to lose the weight and keep it off - Cover story
- Treat sinusitis naturally: breath easy and relieve sinus pressure with these remedies - Quick Fixes and Long-Term Solutions
- All about nightshades: explore the hidden hazards of your favorite food with macrobiotic nutritionist Lino Stanchich
Presented by American Express