High-risk medication use among older adults with cognitive impairment living alone in the United States

• Published in: Journal of the American Geriatrics Society (JAGS) 2024-12, Vol.72 (12), p.3719-3729
• Main Authors: Growdon, Matthew E, Jing, Bocheng, Yaffe, Kristine, Karliner, Leah S, Possin, Katherine L, Portacolone, Elena, Boscardin, W John, Harrison, Krista L, Steinman, Michael A
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Aging; Anticholinergics; Cognitive ability; Cognitive Dysfunction - drug therapy; Cross-Sectional Studies; Dementia; Drug use; Drug-Related Side Effects and Adverse Reactions - epidemiology; Female; Health risks; Humans; Independent Living; Male; Medicare - statistics & numerical data; Older people; Patient safety; Regression analysis; Sulfonylurea; United States - epidemiology
• ISSN: 0002-8614; 1532-5415; 1532-5415
• DOI: 10.1111/jgs.19108

More than one-fourth of older adults with cognitive impairment (CI) live alone; these individuals often lack support for medication management and face a high risk of adverse drug events. We characterized the frequency and types of high-risk medications used by older adults with CI living alone and, for context, compared patterns with those in older adults with CI living with others. This was a cross-sectional study of National Health and Aging Trends Study (NHATS) data and Medicare claims (2015-2017). We ascertained cognitive status from NHATS and medication use with Part D claims. We compared high-risk medication use (those with adverse cognitive effects or low tolerance for misuse) among older adults with CI living alone versus living with others using logistic regression models adjusted for demographic/clinical factors. The unweighted sample included 1569 older adults with CI, of whom 491 (weighted national estimate, 31%) were living alone. In the living-alone group, the mean age was 79.9 years and 66% were female, 64% reported managing medications on their own without difficulty, 14% reported managing medications on their own with difficulty, and 18% received total support with medication management. Older adults with CI living alone used a median of 5 medications (IQR, 3-8), 16% took ≥10 medications, and 46% took ≥1 high-risk medication (anticholinergic/sedating: 24%; opioid: 13%; anticoagulant: 10%; sulfonylurea: 10%; insulin: 9%). Compared with those living with others, the use of high-risk medications was similar (p > 0.05 for unadjusted/adjusted comparisons). Those living alone were more likely both to take at least one high-risk medication and not receive help with medication management: 34% in those living alone versus 23% living with others (p