Deardorff W James, Jing Bocheng, Growdon Matthew E, Motmans Brian, Boscardin W John, Blank Leah J, Boockvar Kenneth S, Steinman Michael A
Division of Geriatrics, University of California, San Francisco, San Francisco, California, USA.
San Francisco Veterans Affairs Medical Center, San Francisco, California, USA.
J Am Geriatr Soc. 2025 Jun 12. doi: 10.1111/jgs.19585.
The association between lower socioeconomic status and increased potentially inappropriate medications (PIMs) among older adults, as seen in some studies, is infrequently studied in persons with dementia (PWD). This association may additionally be impacted by multimorbidity and caregiver support in PWD. Thus, we examined the association between wealth and PIMs in PWD and the effects of comorbidities and caregivers.
We included community-dwelling adults aged ≥ 66 with dementia in the Health and Retirement Study (2008-2018). PIMs included sedative-hypnotics, strongly anticholinergics, and medications from 2019 Beers and STOPP-Version 2 criteria. The primary outcome was a prescription for ≥ 1 PIM. We used logistic regression with national survey weights to examine the association between household wealth (above vs. below sample median) and ≥ 1 PIM through 4 models: (1) unadjusted, (2) adjusted for demographics (age, sex, race/ethnicity), 3) Model 2 + comorbidity count (range 0-7), (4) Model 3 + caregiver type (no caregiver, paid caregiver, unpaid caregiver only).
The cohort consisted of 1475 PWD (median age 84, 67% female, 15% Black, median household wealth $86,000 (IQR 2000-315,000), 49% with unpaid caregiver only, 23% with paid caregiver). Overall, 76% received ≥ 1 PIM. Adjusting for demographics, PWD with below median wealth showed increased odds of receiving ≥ 1 PIM (OR = 1.44, 95% CI = 1.07-1.93). This association was not statistically significant after adjusting for comorbidity count (OR = 1.26, 95% CI = 0.93-1.70). In a stratified analysis by comorbidity count adjusting for demographics and wealth, paid caregiver presence was associated with increased odds of PIMs among individuals with ≤ 2 chronic conditions (OR = 2.60, 95% CI = 1.44-4.69) but not with ≥ 3 chronic conditions (OR = 0.90, 95% CI = 0.50-1.62) (p = 0.02 for interaction).
Among PWD, the association between lower wealth and increased odds of PIMs was no longer statistically significant after adjusting for comorbidity count. Caregiving status had a complex relationship with PIMs based on comorbidity burden.
一些研究表明，社会经济地位较低与老年人潜在不适当用药（PIM）增加之间存在关联，但在痴呆症患者（PWD）中对此关联的研究较少。这种关联可能还会受到PWD的多种合并症和照顾者支持的影响。因此，我们研究了PWD的财富与PIM之间的关联以及合并症和照顾者的影响。
我们纳入了健康与退休研究（2008 - 2018年）中年龄≥66岁的社区居住痴呆症成年人。PIM包括镇静催眠药、强效抗胆碱能药物以及符合2019年Beers标准和STOPP - 第2版标准的药物。主要结局是开具≥1种PIM的处方。我们使用带有全国调查权重的逻辑回归，通过4个模型来研究家庭财富（高于或低于样本中位数）与≥1种PIM之间的关联：（1）未调整，（2）调整人口统计学因素（年龄、性别、种族/民族），（3）模型2 + 合并症数量（范围0 - 7），（4）模型3 + 照顾者类型（无照顾者、付费照顾者、仅无薪照顾者）。
该队列由1475名PWD组成（中位年龄84岁，67%为女性，15%为黑人，家庭财富中位数为86,000美元（四分位距2000 - 315,000美元），49%仅有无薪照顾者，23%有付费照顾者）。总体而言，76%的人接受了≥1种PIM。调整人口统计学因素后，财富低于中位数的PWD接受≥1种PIM的几率增加（OR = 1.44，95%CI = 1.07 - 1.93）。在调整合并症数量后，这种关联无统计学意义（OR =
