Inappropriate Drug Use and Risk of Transition to Nursing Homes Among Community-Dwelling Older Adults

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Abstract
Background: Adverse events from inappropriate medications are preventable risk factors for nursing home admissions. Objective: We sought to investigate the relationship between inappropriate medications in older adults and transitions to nursing home. Methods: A retrospective cohort of Medicare beneficiaries with employer-sponsored supplemental health insurance was analyzed using a longitudinal data set of Medicare supplemental insurance claims. After a baseline year with no nursing home admissions, subjects were followed until the first month of transition to nursing home, loss to follow-up, or the end of the 24-month follow-up period. Survival analysis was used to compare the risk of nursing home transition among those with and without inappropriate drug use in the previous 3 months. Results: Of the 487,383 subjects in the cohort, 22,042 (4.5%) had a nursing home admission. Use of inappropriate drugs was associated with a 31% increase in risk of nursing home admission, compared with no use of inappropriate drugs (adjusted relative risk 1.31, 99% confidence interval [CI] 1.26–1.36). Analyses of individual drug classes showed the risk of nursing home admission was similar, or lower, for inappropriate drugs versus other drugs of the same class. For example, the relative risk of nursing home admission was 2.34 (99% CI 2.20–2.47) for inappropriate narcotics and 2.68 (99% CI 2.55–2.82) for other narcotics, compared with no narcotic use. Conclusion: Inappropriate drug use was associated with increased risk of nursing home transition, but the increased risk may be explained by underlying patient conditions for which the drugs were prescribed rather than the inappropriate drug.