Relationship of Number of Medications to Functional Status,Health,and Quality of Life for the Frail Home-Based Older Adult

Abstract

Number of medications and its relationship to functional status, health, and quality of life in 1,099 frail home-based older adults were examined. Using a general linear model, the number of medications was significant to cognition (P = .004; β = 0.16), instrumental activities of daily living (P < .0001; β = 0.13), and health (P = .0001; odds ratio = 0.92, 95% confidence interval = 0.83 to 0.96). But increased age (P < .0001; β = −.12) and male gender (P < .0001; β = −1.9), inversely associated with cognition, point to the emergence of a high-risk group who have a greater need for occupational therapy intervention, specifically medication management.

Keywords

older adults instrumental activities of daily living medication management

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References

Administration on Aging. (2000). Percent of persons 60+ by race and Hispanic origin by state. Washington, DC: Author. Retrieved January 31, 2004, from http://www.aoa.gov/prof/Statistics/Census2000/2000pop/percent60plusxrace-HO.asp.

Administration on Aging. (2002). A profile of older Americans: 2002. Washington, DC: Author. Retrieved on January 31, 2004, from http://www.aoa.gov/prof/Statistics/profile/7.asp.

AdvancePCS Center for Healthier Aging. (2001, Winter). Health improvement report (pp. 1–8). Irving, TX: Author.

American Society of Health-System Pharmacists. (2000, December). American Society of Health-System Pharmacists snapshot of medication use in the U.S. research report. Bethesda, MD: Author.

Brawn

L. A.

Castleden

C. M.

(1990). Adverse drug reactions: An overview of special consideration in the management of the elderly patient. Drug Safety, 5, 421–435.

Cadieux

R. J.

(1989). Drug interactions in the elderly: How multiple drug use increases risks exponentially. Postgraduate Medicine, 86, 179–186.

Cameron

Richardson

Werner

(2000/2001). A guide to medication and aging. Generations, 24(4), 8–21.

Carr

A. J.

Higginson

I. J.

Robinson

P. G.

(Eds.). (2003). Quality of life. London, England: BMJ Books.

Chutka

D. S.

Evans

J. M.

Fleming

K. C.

Mikkelson

K. G.

(1995). Symposium on Geriatrics: Part One. Drug prescribing for elderly patients. Mayo Clinic Proceedings, 70, 685–693.

10.

Cipolle

R. J.

Strand

L. M.

Morley

P. C.

(1998). Pharmaceutical care practice. New York: McGraw Hill.

11.

Clark

Azen

Zemke

Jackson

Carlson

Mandel

. (1997). Occupational therapy for independent-living older adults: A randomized controlled trial. Journal of the American Medical Association, 278, 1321–1326.

12.

Cook

T. D.

Campbell

D. T.

(1979). Quasi-experimentation: Design and analysis issues for field settings. Boston: Houghton Mifflin.

13.

Cooper

J. W.

(1994). Drug-related problems in the elderly. Generations, 8(2), 11–19.

14.

Doble

S. E.

Fisher

A. G.

(1998) The dimensionality and validity of the Older Americans Resources and Services (OARS) Activities of Daily Living (ADL) scale. Journal of Outcome Measurement, 2(1), 4–24.

15.

Enright

P. L.

McBurnie

M. A.

Bittner

Tracy

R. P.

McNamara

Arnold

. (2003). The 6-min walk test: A quick measure of functional status in elderly adults. Chest, 123, 387–398.

16.

Falvo

D. R.

Holland

Brenner

Benshoff

J. J.

(1990). Medication use practices in the ambulatory elderly. Health Values: The Journal of Health Behavior, Education, & Promotion, 14(3), 10–17.

17.

Flaherty

J. H.

Perry

H. M.

Lynchard

G. S.

Morley

J. E.

(2000). Polypharmacy and hospitalization among home care patients. Journal of Gerontology, 55, M554–M559.

18.

Gallagher

L. P.

(2001). The potential for adverse drug reactions in elderly patients. Applied Nursing Research, 14, 220–224.

19.

Giron

M. S.

Wang

H. X.

Bernsten

Thorslund

Winblad

Fastbom

(2001). The appropriateness of drug use in the older nondemented and demented population. Journal of the American Geriatrics Society, 49, 277–283.

20.

Hanlon

J. T.

Artz

M. B.

(2001). Drug-related problems and pharmaceutical care: What are they, do they matter, and what's next? Medical Care, 39, 109–112.

21.

Hanlon

J. T.

Fillenbaum

G. G.

Kuchibhatla

Artz

M. B.

Boult

Gross

C. R.

. (2002). Impact of inappropriate drug use on mortality and functional status in representative community dwelling elders. Medical Care, 40, 166–176.

22.

Hohl

C. M.

Dankoff

Colacone

Afilalo

(2001). Polypharmacy, adverse drug-related events, and potential adverse drug interactions in elderly patients presenting to an emergency department. Annals of Emergency Medicine, 38, 666–671.

23.

Hughes

C. M.

McElnay

J. C.

Fleming

G. F.

(2001). Benefits and risks of self medication. Drug Safety, 24, 1027–1037.

24.

Iliffe

Haines

Gallivan

Booroff

Goldenberg

Morgan

(1991). Assessment of elderly people in general practice: 2. Functional abilities and medical problems. British Journal of General Practitioners, 41(342), 3–5.

25.

Kempen

G. I. J.

Brilman

E. L.

Ranchor

A. V.

Ormel

(1999). Morbidity and quality of life and the moderating effects of level of education in the elderly. Social Science and Medicine, 49, 143–149.

26.

Klesges

L. M.

Pahor

Short

R. I.

Wan

J. Y.

Williamson

J. D.

Guralnik

J. M.

(2001). Financial difficulty in acquiring food among elderly disabled women: Results from the Women's Health and Aging Study. American Journal of Public Health, 91, 68–75.

27.

Koh

N. Y.

Koo

W. H.

(2002). Polypharmacy in palliative care: Can it be reduced? Singapore Medical Journal, 43, 279–283.

28.

Law

LeClair

Steinwender

(1998). Occupation, health and well-being. Canadian Journal of Occupational Therapy, 65, 81–91.

29.

Leipzig

Edelberg

(2001). Prescribing: Keys to maximizing benefit while avoiding adverse drug effects. Geriatrics, 56, 30–34.

30.

Lyder

Fennie

Chen

Fulmer

(2000). Appropriate prescribing for elders: Disease management alone is not enough. Generations, 24(4), 55–59.

31.

Mann

Karuza

Hurren

Tomita

(1993). Needs of home-based older persons for assistive devices: The University at Buffalo Rehabilitation Engineering Center on Aging Consumer Assessments Study. Technology and Disability, 2(1), 1–11.

32.

Monane

Semla

(1997). Optimum medication use in elders: Key to successful aging. Western Journal of Medicine, 167, 233–237.

33.

Muraki

Nagao

Ishikawa

(2001). A preliminary investigation to explore the effects of daytime physical activity patterns on health-related WOL in healthy community-dwelling elderly subjects. Physical and Occupational Therapy in Geriatrics, 19(2), 51–62.

34.

Njegovan

Hing

M. M.

Mitchell

S. L.

Molnar

F. J.

(2001). The hierarchy of functional loss associated with cognitive decline in older persons. Journal of Gerontology A: Behavioral Science Medical Science, 56, M639–M643.

35.

Onder

Pendone

Landi

Cesari

Della

Vedova C.

Bernabei

. (2002). Adverse drug reactions as cause of hospital admissions: Results from the Italian Group of Pharmacoepidemiology in the Elderly (GIFA). Journal of the American Geriatrics Society, 50, 1962–1968.

36.

Ottenbacher

(1991). Statistical conclusion validity: Multiple inferences in rehabilitation research. American Journal of Physical and Medical Rehabilitation, 70, 317–322.

37.

Pollak

Rheault

Stoecker

J. L.

(1996). Reliability and validity of the FIM for persons aged 80 years and above from a multilevel continuing care retirement community. Archives of Physical Medical Rehabilitation, 77, 1056–1061.

38.

Portney

L. G.

Watkins

M. P.

(2000). Foundations of clinical research: Applications to practice (2nd ed.). Upper Saddle River, NJ: Prentice Hall Health.

39.

Rathore

S. S.

Mehta

S. S.

Boyko

W. L.

Jr. Schulman

K. A.

(1998). Prescription medication use in older Americans: A national report card on prescribing. Family Medicine, 30, 733–739.

40.

Rehabilitation Engineering Research Center on Aging Center for Assistive Technology. (2000). Consumer Assessment Study: Evaluating quality of life of home-based elders with disability. Buffalo, NY: State University of New York at Buffalo.

41.

Reuben

D. B.

Valle

L. A.

Hays

R. D.

Siu

A. L.

(1995). Measuring physical function in community-dwelling older persons: A comparison of self-administered, interviewer-administered, and performance-based measures. Journal of the American Geriatrics Society, 43, 17–23.

42.

Rogers

J. C.

Holm

M. B.

(1998). Evaluation of occupational performance areas. In Neistadt

M. E.

Crepeau

E. B.

(Eds.), Willard and Spackman's occupational therapy (9th ed., pp. 185–222). Philadelphia: Lippincott, Williams, and Wilkins.

43.

Rubin

C. D.

Sizemore

M. T.

Loftis

P. A.

de Mola

N. L.

(1993). A randomized controlled trial of outpatient geriatric evaluation and management in a large public hospital. Journal of the American Geriatrics Society, 41, 1023–1028.

44.

Ruiz

J. G.

Array

Lowenthal

D. T.

(1996). Avoiding over-medication of elderly patients. American Journal of Therapeutics, 3, 784–788.

45.

Schmader

K. E.

Hanlon

J. T.

Fillenbaum

G. C.

Huber

Pieper

Horner

(1998). Medication use patterns among the demented, cognitively impaired and cognitively intact community-dwelling elderly people. Age and Ageing, 27, 493–501.

46.

Spina

Scordo

(2002). Clinically significant drug interactions with antidepressants in the elderly. Drugs Aging, 19, 299–320.

47.

Stuck

A. E.

Walthert

J. M.

Nikolaus

Bula

C. J.

Hohmann

Beck

J. C.

(1999). Risk factors for functional status decline in community-living elderly people: A systematic literature review. Social Science and Medicine, 48, 445–469.

48.

Thomas

V. S.

Rockwood

McDowell

(1998). Multidimensionality in instrumental and basic activities of daily living. Journal of Clinical Epidemiology, 51, 315–321.

49.

U.S. Census Bureau. (2002). Projections of the total resident population by 5-year age groups and sex with special age categories: Middle series, 1999 to 2000. Washington, DC: Author. Retrieved August 16, 2003, from http://www.census.gov/population/projections/nation/summary/np-t3-a.txt.

50.

Veehof

L. J.

Stewart

R. E.

Meyboom-De

Jong B.

Haaijer-Ruskamp

F. M.

(1999). Adverse drug reactions and polypharmacy in the elderly in general practice. European Journal of Clinical Pharmacology, 55, 533–536.

51.

Wald

N. J.

Law

M. R.

(2003). A strategy to reduce cardiovascular disease by more than 80. British Medical Journal, 326, 1419.