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Medication Undertreatment in Assisted Living Settings
Philip D. Sloane, MD, MPH;
Ann L. Gruber-Baldini, PhD;
Sheryl Zimmerman, PhD;
Mary Roth, PharmD, MHS;
Lea Watson, MD, MPH;
Malaz Boustani, MD, MPH;
Jay Magaziner, PhD;
J. Richard Hebel, PhD
Arch Intern Med. 2004;164:2031-2037.
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  -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.
From the Program on Aging, Disability, and Long-Term Care, Cecil G. Sheps Center for Health Services Research (Drs Sloane and Zimmerman), the Department of Family Medicine (Dr Sloane), the School of Social Work (Dr Zimmerman), the School of Pharmacy (Dr Roth), and the Department of Psychiatry (Dr Watson), University of North Carolina, Chapel Hill; the Department of Epidemiology (Drs Gruber-Baldini, Magaziner, and Hebel), University of Maryland School of Medicine, Baltimore; and the Indiana University School of Medicine, Indianapolis (Dr Boustani). The authors have no relevant financial interest in this article.
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