Growdon Matthew E, Jing Bocheng, Yaffe Kristine, Karliner Leah S, Possin Katherine L, Portacolone Elena, Boscardin W John, Harrison Krista L, Steinman Michael A
Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA.
San Francisco VA Medical Center, San Francisco, California, USA.
J Am Geriatr Soc. 2024 Dec;72(12):3719-3729. doi: 10.1111/jgs.19108. Epub 2024 Jul 26.
More than one-fourth of older adults with cognitive impairment (CI) live alone; these individuals often lack support for medication management and face a high risk of adverse drug events. We characterized the frequency and types of high-risk medications used by older adults with CI living alone and, for context, compared patterns with those in older adults with CI living with others.
This was a cross-sectional study of National Health and Aging Trends Study (NHATS) data and Medicare claims (2015-2017). We ascertained cognitive status from NHATS and medication use with Part D claims. We compared high-risk medication use (those with adverse cognitive effects or low tolerance for misuse) among older adults with CI living alone versus living with others using logistic regression models adjusted for demographic/clinical factors.
The unweighted sample included 1569 older adults with CI, of whom 491 (weighted national estimate, 31%) were living alone. In the living-alone group, the mean age was 79.9 years and 66% were female, 64% reported managing medications on their own without difficulty, 14% reported managing medications on their own with difficulty, and 18% received total support with medication management. Older adults with CI living alone used a median of 5 medications (IQR, 3-8), 16% took ≥10 medications, and 46% took ≥1 high-risk medication (anticholinergic/sedating: 24%; opioid: 13%; anticoagulant: 10%; sulfonylurea: 10%; insulin: 9%). Compared with those living with others, the use of high-risk medications was similar (p > 0.05 for unadjusted/adjusted comparisons). Those living alone were more likely both to take at least one high-risk medication and not receive help with medication management: 34% in those living alone versus 23% living with others (p < 0.05 for unadjusted/adjusted comparisons).
Older adults with CI living alone use many medications; nearly half use high-risk medications. Our findings can inform medication optimization interventions supporting this vulnerable population.
超过四分之一的认知障碍（CI）老年人独自生活；这些人往往缺乏药物管理方面的支持，面临药物不良事件的高风险。我们对独自生活的CI老年人使用高风险药物的频率和类型进行了特征描述，并与与他人共同生活的CI老年人的用药模式进行了比较。
这是一项对国家健康与老龄化趋势研究（NHATS）数据和医疗保险理赔（2015 - 2017年）的横断面研究。我们从NHATS确定认知状态，并通过D部分理赔确定用药情况。我们使用针对人口统计学/临床因素进行调整的逻辑回归模型，比较独自生活与与他人共同生活的CI老年人中高风险药物的使用情况（那些具有不良认知影响或对误用耐受性低的药物）。
未加权样本包括1569名CI老年人，其中491人（全国加权估计为31%）独自生活。在独自生活组中，平均年龄为79.9岁，66%为女性，64%报告自行管理药物无困难，14%报告自行管理药物有困难，并18%接受药物管理的全面支持服务。独自生活CI老年人的用药中位数为5种（四分位间距为3至8种）；16%服用≥10种药物；46%服用≥1种高风险药物（抗胆碱能/镇静类：24%；阿片类：13%；抗凝剂：10%；磺脲类：10%；胰岛素：9%）。与与他人共同生活的老年人相比，高风险药物使用情况相似（未调整/调整后的比较中p>0.05）。独自生活的老年人服用至少一种高风险药物且未接受药物管理帮助的可能性更大：独自生活者中为34%，与他人共同生活者中为23%（未调整/调整后的比较中p<0.05）。
独自生活CI老年人使用多种药物；近半数使用高风险药物。我们的研究结果可为支持这一弱势群体的药物优化干预措施提供参考。
