Characteristics associated with four potential medication problems among older adults in Medicaid waiver services

To identify characteristics associated with four potential medication problems among older adults at risk for nursing home placement.

Cross-sectional survey.

Three sites of California's Multipurpose Senior Services Program (MSSP), a Medi-Cal waiver care management program.

Six hundred fifteen dual-eligible, functionally impaired, community-dwelling adults aged 65 years and older enrolled in MSSP between June 2004 and January 2006.

Medication screening using the Home Health Criteria that include medication use and clinical risk factors.

Demographic and health characteristics associated with four problem types: 1) unnecessary therapeutic duplication, 2) psychotropic medication use with concurrent falls or confusion, 3) cardiovascular medication problems, and 4) use of nonsteroidal anti-inflammatory drugs (NSAIDs) with risk of peptic ulcer complications. Independent measures included age, gender, race/ethnicity, living arrangement, number of medications, health status, and utilization.

Each problem type was associated with different characteristics, as identified by logistic regression modeling. Increased number of medications was associated with therapeutic duplication (odds ratio [OR] = 1.27; confidence interval [CI] 1.20-1.35; P < 0.001) and problematic psychotropic medication use (OR = 1.15; CI 1.08-1.22; P < 0.001). Psychotropic use was also associated with emergency department, hospital, or skilled nursing admission in the previous year (OR = 1.86; CI 1.15-3.00; P = 0.012), living with someone (OR = 0.57; CI 0.34-0.95; P = 0.032), and new care management enrollment (OR = 1.99; CI 1.22-3.24; P = 0.006). New enrollment was also associated with cardiovascular medication problems (OR = 2.15; CI 1.32-3.51; P = 0.002). There were no significant characteristics associated with NSAID problems (not shown).

Unique predictors of potential medication problems highlight the need for systematic medication screening and treatment planning. These should include medication therapy management for vulnerable community-dwelling elders (upon enrollment for care management) and for those taking multiple medications. Funding mechanisms via Medicare Part D (prescription drug program) should be explored in this population to increase identification of medication problems and their resolution.