Characterization of medication regimens in older adult self-negelct: Polypharmacy, potentially inappropriate medication use, and potential drug-drug interactions
Self-neglect, the inability or unwillingness to care for oneself, is a commonly-observed issue among older adult clients reported to Adult Protective Services (APS) and is associated with increased mortality and hospitalization rates. Recent studies suggest that self-neglecting older adults have different patterns of medication use and adherence than community-dwelling older adults without self-neglect. Polypharmacy, potentially inappropriate medication (PIM) use, and potential drug-drug interactions (pDDIs) are prevalent issues within the general U.S. older adult population, but they have not yet been studied among those who self-neglect. This study aimed to quantify polypharmacy, PIM use, and pDDIs in a sample of older adults with APS-substantiated self-neglect and to compare rates of polypharmacy, PIM use, and pDDIs (including an exploratory analysis of pDDI severity) between self-neglect and community comparison samples. This study was a cross-sectional secondary analysis of data from four primary studies (conducted 2005-2015) in Harris County, Texas. In total, 246 subjects with APS-substantiated self-neglect from were included in an analysis of polypharmacy, PIM use, and pDDIs. Of those, 86 were involved in comparative analysis of these measures alongside a sample of 96 comparison subjects. Polypharmacy was assessed by medication count, PIM use was quantified using the 2015 Beers Criteria, and pDDIs were identified using Micromedex® software. Bivariate statistical calculations (two-sample proportion and t-tests) and multivariable linear regressions (controlling for number of medications taken) were conducted to identify differences between the self-neglect and comparison samples on these medication-related measures. Rates of polypharmacy (70.4%), PIM use (88.7%), and pDDIs (73.7%) were high in the self-neglect sample compared to literature estimates for the general older adult population. No significant differences between self-neglect and comparison subjects were observed in the bivariate calculations, but controlling for number of medications revealed a higher number of pDDIs on average (“major” pDDIs in particular) in the self-neglect group (p = 0.033 for pDDIs, p = 0.046 for “major” pDDIs). Drug interactions therefore represent a key area of future research in understanding poor health outcomes in self-neglect. Future interventions in the self-neglect population should account for high rates of polypharmacy, PIMs, and pDDIs before attempting to change medication-related behaviors.
Abada, Sharon Rose, "Characterization of medication regimens in older adult self-negelct: Polypharmacy, potentially inappropriate medication use, and potential drug-drug interactions" (2016). Texas Medical Center Dissertations (via ProQuest). AAI10249434.