Patterns of medication utilization among older adults in US nursing homes

Purpose: To examine the patterns of medication use, and potential underuse or overuse in a nationally representative sample of older adults (65+) residing in US nursing homes. Background: Literature on prescription medication utilization in the nursing home population is limited and typically not from nationally representative populations. Methods: We used data from the 2004 National Nursing Home Survey (NNHS) and included all sampled residents > 65. We assessed overall medication use and identified the prevalence of organ system groupings of medications as well as individual classes (e.g. statins). We then evaluated the prevalence of medication use in residents with relative contraindications (e.g. chronic constipation). Frequencies were used to identify trends by age (65-74, 75-84, 85+). All data were weighted to be nationally representative. Results: Medication utilization was common, 80.0% took > 5 medications. The tendency to use more medications decreased slightly with age. The three most utilized classes were hematologic, central nervous system and cardiovascular/renal agents, overall and by age category. The prevalence of cardiovascular/renal agents was similar by age, although the use of statins declined substantially (23.9% in 65-74, 18.6% in 75-84 and 8.9% in 85+). Three percent of residents with chronic constipation and 1.0% of residents with Parkinson's disease took medications that were relatively contraindicated. Conclusions: Medication use among older nursing home residents remains staggering. Several classes of medications decreased with advancing age and other medications were utilized when they were potentially contraindicated. More information is needed to understand age-related prescribing decisions including physician, patient and system factors.