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Impact of inappropriate drug use on mortality and functional status in representative community dwelling elders
Joseph T Hanlon1, Gerda G Fillenbaum, Maggie Kuchibhatla
1Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN 55455, USA. hanlo004@tc.umn.edu
Background:
The predictive validity of Drug Utilization Review (DUR) and drugs-to-avoid criteria in elders is unknown.
Objectives:
To evaluate the relationship between use of inappropriate drugs as determined by these explicit criteria and mortality and decline in functional status in community dwelling elders.
Research Design:
Cohort study.
Subjects:
The fourth wave (3234 participants) of the Duke Established Populations for Epidemiologic Studies of the Elderly.
Measures:
Two sets of inappropriate drug-use criteria: (1) DUR with respect to dosage, duplication, drug-drug interactions, duration, and drug-disease interactions; and (2) Beers-modified criteria regarding drugs-to-avoid were applied to drug use reported in an in-home interview. Death was identified from the National Death Index; change in four functional status measures (basic self-care, intermediate self-care, complex self-management, physical function) was determined during the following 3 years.
Results:
Use of inappropriate drugs identified by either set of criteria was not significantly associated with mortality. The drugs-to-avoid criteria identified no significant associations between use of these drugs and decline in functional status. With DUR criteria, however, the association between use of inappropriate drugs and basic self-care was significant and pronounced among those with drug-drug or drug-disease interaction problems (Adj. OR 2.04; 95% CI 1.32-3.16).
Conclusions:
Identifying the impact of inappropriate drug use may depend on the criteria applied. Further studies are needed that measure additional outcomes and use alternate measures of inappropriate drug use.