The online version of this article (https://doi.org/10.1186/s12877-018-0704-8) contains supplementary material, which is available to authorized users.
The potential harms of some medications may outweigh their potential benefits (inappropriate medication use). Despite recommendations to avoid the use of potentially inappropriate medications (PIMs) in older adults, the prevalence of PIM use is high in different settings including residential aged care. However, it remains unclear what the costs of these medications are in this setting. The main objective of this study was to determine the costs of PIMs in older adults living in residential care. A secondary objective was to examine if there was a difference in costs of PIMs in a home-like model of residential care compared to an Australian standard model of care.
Participants included 541 participants from the Investigation Services Provided in the Residential Environment for Dementia (INSPIRED) Study. The INSPIRED study is a cross-sectional study of 17 residential aged care facilities in Australia. 12 month medication costs were determined for the participants and PIMs were identified using the 2015 updated Beers Criteria for older adults.
Of all of the medications dispensed in 1 year, 15.9% were PIMs and 81.4% of the participants had been exposed to a PIM. Log-linear models showed exposure to a PIM was associated with higher total medication costs (Adjusted β = 0.307, 95% CI 0.235 to 0.379, p < 0.001). The mean proportion (±SD) of medication costs that were spent on PIMs in 1 year was 17.5% (±17.8) (AUD$410.89 ± 479.45 per participant exposed to a PIM). The largest PIM costs arose from proton-pump inhibitors (34.4%), antipsychotics (21.0%) and benzodiazepines (18.7%). The odds of incurring costs from PIMs were 52% lower for those residing in a home-like model of care compared to a standard model of care.
The use of PIMs for older adults in residential care facilities is high and these medications represent a substantial cost which has the potential to be lowered. Further research should investigate whether medication reviews in this population could lead to potential cost savings and improvement in clinical outcomes. Adopting a home-like model of residential care may be associated with reduced prevalence and costs of PIMs.
Additional file 1: Table S1. Complete list of medications considered potentially inappropriate, according to the Beers Criteria, and adapted for an Australian setting. (DOCX 31 kb)12877_2018_704_MOESM1_ESM.docx
American Geriatrics Society. American Geriatrics Society 2015 updated beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2015;63(11):2227–46.
Heider D, Matschinger H, Meid AD, Quinzler R, Adler J-B, Günster C, Haefeli WE, König H-H. Health service use, costs, and adverse events associated with potentially inappropriate medication in old age in Germany: retrospective matched cohort study. Drugs Aging. 2017;34(4):289-301.
World report on ageing and health. http://www.who.int/ageing/events/world-report-2015-launch/en/. Accessed 8 Jan 2018.
Ausserhofer D, Deschodt M, De Geest S, van Achterberg T, Meyer G, Verbeek H, Sjetne IS, Malinowska-Lipien I, Griffiths P, Schluter W, et al. “There's no place like home”: a scoping review on the impact of homelike residential care models on resident-, family-, and staff-related outcomes. J Am Med Dir Assoc. 2016;17(8):685–93. CrossRefPubMed
PBS Publications Archive. http://www.pbs.gov.au/info/publication/schedule/archive. Accessed 8 Jan 2018.
DPMQ. https://dev.pbs.gov.au/docs/glossary/DPMQ.html. Accessed 8 Jan 2018.
Foreign exchange rates, monthly rates. https://www.ato.gov.au/Tax-professionals/TP/1-July-2015-to-30-June-2016/. Accessed 8 Jan 2018.
Somers M, Rose E, Simmonds D, Whitelaw C, Calver J, Beer C. Quality use of medicines in residential aged care. Aust Fam Physician. 2010;39(6):413–6. PubMed
Guideline Adaptation Committee. Clinical practice guidelines and principles of Care for People with dementia. Sydney: Guideline Adaptation Committee; 2016.
Brodaty H, Draper B, Low L. Behavioural and psychological symptoms of dementia: a seven-tiered model of service delivery. MJA. 2003;178(5):231–4. PubMed
Department of Health and Ageing, Australian Government. 2011-12. Report on the Operation of the Aged Care Act. https://www.agedcarecrisis.com/images/ar/ROACA-2011-2012.pdf. Accessed 8 Jan 2018.
Gnanamanickam ES, Dyer SM, Milte R, Harrison SL, Liu E, Easton T, Bradley C, Bilton R, Shulver W, Ratcliffe J, et al. Direct health and residential care costs of people living with dementia in Australian residential aged care. Int J Geriatr Psychiatry. 2018. Epub ahead of print.
- Costs of potentially inappropriate medication use in residential aged care facilities
S. L. Harrison
L. Kouladjian O’Donnell
S. M. Dyer
E. S. Gnanamanickam
S. N. Hilmer
- BioMed Central
Neu im Fachgebiet Innere Medizin
Meistgelesene Bücher aus der Inneren Medizin
Mail Icon II