Hospitalization and Death Associated With Potentially Inappropriate Medication Prescriptions Among Elderly Nursing Home Residents

ABSTRACT Background This study examines the association of potentially inappropriate medication prescribing (PIRx) with hospitalization and death among elderly long-stay nursing home residents. Methods We defined PIRx using the combined version of the Beers criteria. Data were from the 1996 Medical Expenditure Panel Survey Nursing Home Component. The study sample included 3372 residents, 65 years and older, who had nursing home stays of 3 consecutive months or longer in 1996. We performed multivariate logistic regression analyses of longitudinal data using generalized estimating equations. Results Residents who received any PIRx had greater odds (odds ratio [OR], 1.27; P = .002) of being hospitalized in the following month than those receiving no PIRx. Residents with PIRx exposure for 2 consecutive months were at increased risk (OR, 1.27; P = .004) of hospitalization, as were those receiving PIRx in the second month only (OR, 1.80; P = .001), compared with those receiving no PIRx. Residents who received PIRx were at greater risk of death (OR, 1.28; P = .01) that month or the next. Residents with intermittent PIRx exposures were at greater odds of death (OR, 1.89; P<.001), compared with those with no PIRx exposure. Conclusions The association of PIRx with subsequent adverse outcomes (hospitalization and death) provides new evidence of the importance of improving prescribing practices in the nursing home setting. Arch Intern Med. 2005;165:68-74. January 10, 2005 Author Affiliations: Buehler Center on Aging, Feinberg School of Medicine, Northwestern University, Chicago, Ill (Dr Lau); Department of Health Policy and Management, Bloomberg School of Public Health (Dr Kasper), and Division of Geriatric Medicine and Gerontology, School of Medicine (Dr Bennett), The Johns Hopkins University, Baltimore, Md; Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality, Rockville, Md (Ms Potter); and School of Government and Public Administration, University of Baltimore (Dr Lyles).