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Potentially Inappropriate Medication Prescriptions among Elderly Nursing Home Residents: Their Scope and Associated Resident and Facility Characteristics


  • Denys T. Lau,

  • Judith D. Kasper,

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    • Address correspondence to Judith D. Kasper, Ph.D., Professor, Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Room 641, Baltimore, MD 21205. Denys T. Lau, Ph.D., is Pfizer Research Fellow, Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI. D. E. B. Potter, M.S., is a Senior Survey Statistician, Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Rockville, MD. Alan Lyles, Sc.D., is Henry A. Rosenberg Professor of Public, Private and Nonprofit Partnerships, School of Government and Public Administration, University of Baltimore, Baltimore, MD.

  • D. E. B. Potter,

  • Alan Lyles

  • An earlier version of this manuscript was presented at the Drug Information Association Third Annual Workshop on Pharmaceutical Outcomes Research 2001, and the American Public Health Association One Hundred and Twenty-Ninth Annual Conference 2001. Research was conducted when Denys Lau was a program analyst at the Center for Cost and Financing Studies, Agency for Healthcare Research and Quality (AHRQ), Department of Health and Human Services (DHHS), and funding for this project was provided by AHRQ intramural funds. The opinions expressed are solely those of the authors. No official endorsement by DHHS or AHRQ is intended or should be inferred.


Objective. To estimate the scope of potentially inappropriate medication prescriptions (PIRx) among elderly residents in U.S. nursing homes (NHs), and to examine associated resident and facility characteristics.

Data Sources. The 1996 Medical Expenditure Panel Survey Nursing Home Component (MEPS NHC), a survey of a nationally representative sample of NHs and residents.

Study Design. The PIRx, defined by Beers's consensus criteria (1991, 1997), was identified using up to a year's worth of NH prescribed medicine data for each resident. The study sample represented 1.6 million NH residents (n=3,372).

Results. At a minimum, 50 percent of all residents aged 65 or older, with an NH stay of three months or longer received at least one PIRx in 1996. The most common PIRx involved propoxyphene, diphenhydramine, hydroxyzine, oxybutynin, amitriptyline, cyproheptadine, iron supplements, and ranitidine. Resident factors associated with greater odds of PIRx were Medicaid coverage, no high school diploma, and nondementia mental disorders. Facility factors were more beds and lower RN-to-resident ratio. Factors associated with lower odds of PIRx were fewer medications, residents with communication problems, and being in an accredited NH. Onsite availability of pharmacists or mental health providers was not related.

Implications. With quality of care and patient safety as major public health concerns, effective policies are needed to avoid PIRx occurrences and improve the quality of prescribing among elderly residents in NHs. Additional studies are needed to determine the impact of PIRx on this NH population.