Improving Medication Outcomes in Older People

Cost-Related Medication Nonadherence Among Older Adults: Findings From a Nationally Representative Sample

OBJECTIVES

To estimate the rate of and risk factors associated with cost-related medication nonadherence among older adults.

DESIGN

Cross-sectional analysis of the 2017 National Health Interview Survey (NHIS).

SETTING

Nationally representative health interview survey in the United States.

PARTICIPANTS

Survey respondents, aged 65 years or older (n = 5701 unweighted) in the 2017 wave of the NHIS.

MEASUREMENTS

Self-reported, cost-related medication nonadherence (due to cost: skip dose, reduce dose, or delay or not fill a prescription) and actions taken due to cost-related medication nonadherence (ask for lower-cost prescription, use alternative therapy, or buy medications from another country) were quantified. We used a series of multivariable logistic regression analyses to identify factors associated with cost-related medication nonadherence. We also reported analyses by chronic disease subgroups.

RESULTS

In 2017, 408 (6.8%) of 5901 older adults, representative of 2.7 million older adults nationally, reported cost-related medication nonadherence. Among those with cost-related medication nonadherence, 44.2% asked a physician for lower-cost medications, 11.5% used alternative therapies, and 5.3% bought prescription drugs outside the United States to save money. Correlates independently associated with a higher likelihood of cost-related medication nonadherence included: younger age, female sex, lower socioeconomic levels (eg, low income and uninsured), mental distress, functional limitations, multimorbidities, and obesity (P < .05 for all). Similar patterns were found in subgroup analyses.

CONCLUSION

Cost-related medication nonadherence among older adults is increasingly common, with several potentially modifiable risk factors identified. Interventions, such as medication therapy management, may be needed to reduce cost-related medication nonadherence in older adults. J Am Geriatr Soc 67:2463-2473, 2019.

Evaluation of Pharmacist Involvement in Medicare Wellness Visits

PURPOSE

To evaluate the difference in the number of drug therapy interventions between patients seen by pharmacists and patients seen by nonpharmacist providers during Medicare Annual Wellness Visits (AWVs).

METHODS

Pharmacists completed the medication history portion of AWVs at a primary care, interdisciplinary clinic in Central Texas. Drug therapy problems were collected and compared to those identified by physicians conducting AWVs. Drug therapy problems were grouped into 4 categories: indication, effectiveness, safety, and adherence. Each category was divided into subcategories to further specify the problem.

RESULTS

Fifty patients received an AWV in each group. Pharmacists identified more drug therapy problems in all 4 categories as compared to physicians (100 vs 20 interventions, respectively) and significant differences were detected in most subcategories: indication without medication (P = .005), suboptimal regimen (P = .0034), drug-drug interaction (P = .0267), warning/precaution requiring additional monitoring (P = .0267), nonadherence (P = .0058), and patient lack of understanding medication therapy (P = .005).

CONCLUSION

Pharmacist involvement in AWVs helped identify drug therapy problems.

Avoidance of polypharmacy and excessive blood pressure control is associated with improved renal function in older patients

BACKGROUND

Elderly patients are particularly susceptible to polypharmacy. The present study evaluated the renal effects of optimizing potentially nephrotoxic medications in an older population.

METHODS

Retrospective study of patients' ≥ 60 years treated between January of 2013 and February of 2015 in a Nephrology Clinic. The renal effect of avoiding polypharmacy was studied.

RESULTS

Sixty-one patients were studied. Median age was 81 years (range 60-94). Twenty-five patients (41%) were male. NSAIDs alone were stopped in seven patients (11.4%), a dose reduction in antihypertensives was done in 11 patients (18%), one or more antihypertensives were discontinued in 20 patients (32.7%) and discontinuation and dose reduction of multiple medications was carried out in 23 patients (37.7%). The number of antihypertensives was reduced from a median of 3 (range of 0-8) at baseline to a median of 2 (range 0-7), p < 0.001 after intervention. After intervention, the glomerular filtration rate (GFR) improved significantly, from a baseline of 32 ± 15.5 cc/min/1.73 m(2) to 39.5 ± 17 cc/min/1.73 m(2) at t1 (p < 0.001) and 44.5 ± 18.7 cc/min/1.73 m(2) at t2 (p < 0.001 vs. baseline). In a multivariate model, after adjusting for ACEIs/ARBs discontinuation/dose reduction, NSAIDs use and change in DBP, an increase in SBP at time 1 remained significantly associated with increments in GFR on follow-up (estimate = 0.20, p = 0.01).

CONCLUSIONS

Avoidance of polypharmacy was associated with an improvement in renal function.

Experimental gerontological research in Australia

Recently there has been recognition in Australia of the importance of experimental gerontological research. To date, the major areas of research into the biology of ageing have been oxidative stress and mitochondrial dysfunction. Future directions for gerontological research in Australia are likely to place more emphasis on comprehensive studies that integrate basic biological research, with clinical studies and the behavioural and social domains of ageing. Priority will be given to studies incorporating biological markers that are population based and longitudinal. The growing interest in experimental gerontological research complements Australian research strengths in other domains such as disease-based research, social gerontology, population studies and health policy research.