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Medication undertreatment in assisted living settings
Philip D Sloane1, Ann L Gruber-Baldini, Sheryl Zimmerman
1Program on Aging, Disability, and Long-Term Care, Cecil G. Sheps Center for Health Services Research, the Department of Family Medicine,University of North Carolina, Chapel Hill, USA. psloane@med.unc.edu
Archives of Internal Medicine
|October 13, 2004
Summary
Medication undertreatment is common in residential care/assisted living (RC/AL) facilities, impacting older adults. Facility type and physician visit frequency, not patient factors, influenced nonprescribing of proven beneficial medications.
Area of Science:
- Gerontology
- Health Services Research
- Pharmacology
Background:
- Residential care/assisted living (RC/AL) is a growing long-term care sector.
- Medication use in RC/AL settings requires further investigation.
- Prevalence of nonprescribing for evidence-based medications is largely unknown.
Purpose of the Study:
- To determine the prevalence of nonprescribing for key medications in RC/AL facilities.
- To identify predictors of medication nonprescribing in this population.
Main Methods:
- Survey of 193 RC/AL facilities across four states.
- Data collected on 2014 residents aged 65+ including medical records and assessments.
- Logistic regression analysis to identify associations between nonprescribing and patient/facility factors.
Main Results:
- High rates of nonprescribing observed for conditions like congestive heart failure (62.2% not on ACE inhibitors) and prior myocardial infarction (60.5% not on aspirin).
- Significant undertreatment noted for stroke (37.5% not on anticoagulants/antiplatelets) and osteoporosis (61.0% not on calcium).
- Patient characteristics were rarely associated with nonprescribing; facility type and physician visit frequency were more significant predictors.
Conclusions:
- Undertreatment of evidence-based medications is prevalent in RC/AL settings.
- Focusing on facility-level factors may improve medication prescribing.
- Addressing undertreatment is crucial for maintaining resident independence and reducing morbidity.