School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR, USA; Institute on Aging, College of Urban and Public Affairs, Portland State University, Portland, OR, USA.
Institute on Aging, College of Urban and Public Affairs, Portland State University, Portland, OR, USA; Nohad A. Toulan School of Urban Studies and Planning, Portland State University, Portland, OR, USA.
J Am Med Dir Assoc. 2021 Jul;22(7):1548-1552.e2. doi: 10.1016/j.jamda.2020.12.030. Epub 2021 Jan 28.
Explore community- and resident-level characteristics associated with polypharmacy and use of cognition-enhancing, antipsychotic, and opioid medications among a statewide representative sample of assisted living and residential care (AL/RC) residents.
Cross-sectional, descriptive.
A total of 1135 AL/RC residents living in 387 licensed communities in Oregon were recruited. One-third of residents lived in communities certified to provide memory care to residents with dementia.
All licensed AL/RC communities received a mail survey with questions about 3 randomly selected residents' demographic, health service use, health conditions, medication use, and payment information. We estimated bivariate and multiple logistic regression models, resulting in unadjusted and adjusted odds ratios of resident- and community-level characteristics associated with each medication use indicator.
One in 5 residents took a cognition-enhancing medication (20%) in the prior 7 days. Just more than one-fifth (22%) and one-quarter (25%) of residents took opioid or antipsychotic medications, on a scheduled or as-needed basis in the prior 7 days, respectively. Residents with Alzheimer's disease or related dementia (ADRD) living in rural communities were half as likely to take cognitive-enhancing medications compared with their urban counterparts. When controlling for all resident and community covariates, residents with ADRD were almost 3 times as likely to receive an antipsychotic and half as likely to receive an opioid compared to residents without an ADRD diagnosis.
Understanding variation in the use of medications associated with behavioral expressions of ADRD in AL/RC residents is a crucial clinical and policy area.
探索与辅助生活和住宅护理（AL/RC）居民的多种药物治疗和使用认知增强药物、抗精神病药物和阿片类药物相关的社区和居民水平特征，该研究在俄勒冈州全州范围内具有代表性的样本中进行。
横断面、描述性。
共招募了 1135 名居住在俄勒冈州 387 个有执照的社区中的 AL/RC 居民，其中三分之一的居民居住在为患有痴呆症的居民提供记忆护理的认证社区中。
所有持照的 AL/RC 社区都收到了一份邮件调查，其中包含关于 3 名随机选择的居民的人口统计学、卫生服务使用情况、健康状况、用药情况和支付信息的问题。我们估计了居民和社区水平特征与每种药物使用指标相关的双变量和多变量逻辑回归模型，得出未经调整和调整后的居民和社区水平特征与每种药物使用指标相关的比值比。
五分之一的居民（20%）在过去 7 天内服用了认知增强药物。略多于五分之一（22%）和四分之一（25%）的居民在过去 7 天内分别按计划或按需服用了阿片类药物或抗精神病药物。居住在农村社区的患有阿尔茨海默病或相关痴呆症（ADRD）的居民服用认知增强药物的可能性是城市居民的一半。在控制所有居民和社区协变量后，与没有 ADRD 诊断的居民相比，患有 ADRD 的居民服用抗精神病药物的可能性几乎增加了 3 倍，服用阿片类药物的可能性则降低了一半。
了解与 ADRD 行为表现相关的药物在 AL/RC 居民中的使用情况的差异是一个至关重要的临床和政策领域。
