Medication undertreatment in assisted living settings

Philip D. Sloane, Ann L. Gruber-Baldini, Sheryl Zimmerman, Mary Roth, Lea Watson, Malaz Boustani, Jay Magaziner, J. Richard Hebel

Research output: Contribution to journalArticle

95 Citations (Scopus)

Abstract

Background: Residential care/assisted living (RC/AL) is a rapidly growing, long-term care setting, where medication use has not been carefully examined. We sought to determine the prevalence and predictors of nonprescribing of selected medications whose value in decreasing morbidity has been established in clinical trials. Methods: As part of a survey of a stratified random sample of 193 RC/AL facilities in Florida, Maryland, New Jersey, and North Carolina, data were gathered on 2014 residents 65 years and older. Patient characteristics and diagnoses were recorded based on medical record reviews and in-person patient assessments; all medications administered at least 4 of the previous 7 days were recorded. Data on facility characteristics were obtained by interviewing facility administrators. Bivariate and multivariate logistic regression was performed to identify associations between medication nonprescribing and facility characteristics, physician visitation, and patient age, sex, race, comorbidity, functional dependency, and cognition. Results: Of 328 subjects with congestive heart failure, 204 (62.2%) were not receiving an angiotensin-converting enzyme inhibitor; of 172 subjects with prior myocardial infarction, 60.5% were not receiving aspirin and 76.2% were not receiving β-blockers; of 435 patients with history of stroke, 37.5% were not receiving an anticoagulant or antiplatelet agent; and of 315 patients with osteoporosis, 61.0% were not receiving calcium supplementation and 51.1% were not receiving any treatment for the condition. Resident age, race, sex, comorbidity, cognitive status, and dependency in activities of daily living were rarely associated with nonprescribing; in contrast, facility factors - particularly facility type and the frequency of physician visits - were somewhat more frequently associated with nonprescribing. Conclusions: Undertreatment appears to be prevalent in RC/AL facilities. Since preserving independence is often a primary goal of care in these settings, more attention may need to be paid to the use of treatments that have been shown to reduce long-term morbidity.

Original languageEnglish
Pages (from-to)2031-2037
Number of pages7
JournalArchives of Internal Medicine
Volume164
Issue number18
DOIs
StatePublished - Oct 11 2004

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Assisted Living Facilities
Comorbidity
Patient Care Planning
Morbidity
Physicians
Platelet Aggregation Inhibitors
Long-Term Care
Activities of Daily Living
Administrative Personnel
Angiotensin-Converting Enzyme Inhibitors
Anticoagulants
Cognition
Aspirin
Osteoporosis
Medical Records
Primary Health Care
Heart Failure
Logistic Models
Stroke
Myocardial Infarction

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Sloane, P. D., Gruber-Baldini, A. L., Zimmerman, S., Roth, M., Watson, L., Boustani, M., ... Richard Hebel, J. (2004). Medication undertreatment in assisted living settings. Archives of Internal Medicine, 164(18), 2031-2037. https://doi.org/10.1001/archinte.164.18.2031

Medication undertreatment in assisted living settings. / Sloane, Philip D.; Gruber-Baldini, Ann L.; Zimmerman, Sheryl; Roth, Mary; Watson, Lea; Boustani, Malaz; Magaziner, Jay; Richard Hebel, J.

In: Archives of Internal Medicine, Vol. 164, No. 18, 11.10.2004, p. 2031-2037.

Research output: Contribution to journalArticle

Sloane, PD, Gruber-Baldini, AL, Zimmerman, S, Roth, M, Watson, L, Boustani, M, Magaziner, J & Richard Hebel, J 2004, 'Medication undertreatment in assisted living settings', Archives of Internal Medicine, vol. 164, no. 18, pp. 2031-2037. https://doi.org/10.1001/archinte.164.18.2031
Sloane PD, Gruber-Baldini AL, Zimmerman S, Roth M, Watson L, Boustani M et al. Medication undertreatment in assisted living settings. Archives of Internal Medicine. 2004 Oct 11;164(18):2031-2037. https://doi.org/10.1001/archinte.164.18.2031
Sloane, Philip D. ; Gruber-Baldini, Ann L. ; Zimmerman, Sheryl ; Roth, Mary ; Watson, Lea ; Boustani, Malaz ; Magaziner, Jay ; Richard Hebel, J. / Medication undertreatment in assisted living settings. In: Archives of Internal Medicine. 2004 ; Vol. 164, No. 18. pp. 2031-2037.
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