Factors Associated with Medicine Use and Non-use by Ontario Seniors

Impact of Residence on Prevalence and Intensity of Prescription Drug Use Among Older Adults

Background:

Higher levels of morbidity among older adults result in greater need for pharmaceutical products and pharmacy services compared with the need in the general population. Rural residents reportedly have reduced access to healthcare services secondary to transportation difficulties, a limited supply of healthcare workers and facilities, and financial constraints.

Objective:

To examine differences in the prevalence and intensity of prescription pharmaceutical use among urban and rural older adults in Manitoba, Canada.

Methods:

Participant data from the 1996/1997 Manitoba Study of Health and Aging were linked to pharmaceutical claims data recorded in Manitoba Health's Drug Program Information Network. The effect of residence on the prevalence and intensity of drug use was determined, in addition to the effects of other sociodemographic characteristics, measures of health, and health service utilization.

Results:

The prevalence of prescription pharmaceutical use did not differ between urban and rural residents (90.6% vs 89.5%, respectively; p = 0.60). Users of home-care services (OR 1.93; 95% CI 1.09 to 3.39), those who perceived their income as adequate (2.38; 95% CI 1.09 to 5.17), and those with a higher number of chronic health problems (1.42; 95% CI 1.26 to 1.62) were significantly more likely to access prescription medications. Rural and urban residents were equally likely to be high users of prescription drugs (21.3% vs 20.0%, respectively; p = 0.64).

Conclusions:

Poor health status is associated with a higher prevalence and intensity of use of prescription drugs among older Manitobans. Rural residence is not a barrier to receipt of prescription pharmaceuticals.

Use of opioid analgesics among older persons with colorectal cancer in two health districts with palliative care programs

CONTEXT

Prescription of opioid analgesics is a key component of pain management among persons with cancer at the end of life.

OBJECTIVES

To use a population-based method to assess the use of opioid analgesics within the community among older persons with colorectal cancer (CRC) before death and determine factors associated with the use of opioid analgesics.

METHODS

Data were derived from a retrospective, linked administrative database study of all persons who were diagnosed with CRC between January 1, 2001 and December 31, 2005 in Nova Scotia, Canada. This study included all persons who 1) were 66 years or older at the date of diagnosis; 2) died between January 1, 2001 and April 1, 2008; and 3) resided in health districts with formal palliative care programs (PCPs) (n=657). Factors associated with having filled at least one prescription for a so-called "strong" opioid analgesic in the six months before death were examined using multivariate logistic regression.

RESULTS

In all, 36.7% filled at least one prescription for any opioid in the six months before death. Adjusting for all covariates, filling a prescription for a strong opioid was associated with enrollment in a PCP (odds ratio [OR]=3.18, 95% CI=2.05-4.94), residence in a long-term care facility (OR=2.19, 95% CI=1.23-3.89), and a CRC cause of death (OR=1.75, 95% CI=1.14-2.68). Persons were less likely to fill a prescription for a strong opioid if they were older (OR=0.97, 95% CI=0.95-0.99), male (OR=0.59, 95% 0.40-0.86), and diagnosed less than six months before death (OR=0.62, 95% CI=0.41-0.93).

CONCLUSION

PCPs may play an important role in enabling access to end-of-life care within the community.

Rural residence and prescription medication use by community-dwelling older adults: a review of the literature

CONTEXT

Due to various barriers to health care access in the rural setting, there is concern that rural older adults might have lower access to prescribed medications than their urban counterparts.

PURPOSE

To review published research reports to determine prevalence and mean medication use in rural, noninstitutionalized older adults and assess whether rural-urban differences exist.

METHODS

PubMed, Ageline, Cinahl, PsycInfo, International Pharmaceutical Abstracts, Agricola, and Institute for Scientific Information Web of Science - Social Science Index were searched. English-language articles through May 2005 involving a sample of rural, noninstitutionalized older adults and analyses of overall medication prevalence and/or intensity were included. Review articles, conference abstracts, dissertations, books, and articles targeting nonprescription or specific therapeutic categories were excluded. A total of 206 citations were identified and 26 met the inclusion criteria.

FINDINGS

Reported prevalence of prescription medication use by rural older adults varied between 62% and 96%, with 2-6 prescriptions per person. Multivariate analyses results were equally inconsistent. Controlling for insurance, most US studies suggest there is no rural-urban difference in access to prescribed medications. However, this finding may not be generalizable across all regions in the United States or other countries.

CONCLUSIONS

Geographic location may not be as important a variable for medication usage as for other health services utilization.