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Older Adults in Home Health Care at Increased Risk for Unsafe Meds

More than a third of seniors receiving care from a home health agency are taking at least one prescription considered potentially inappropriate, according to a new study.

Dr. Yuhua Bao and colleagues from Weill Cornell Medical College found that home health care patients aged 65 and over are prescribed potentially inappropriate medications, (PIMs), at rates that are three times higher than patients who visit a medical office.

Home health care patients are taking 11 medications on average, according to researchers, and the concurrent use of multiple medications is a strong indicator of the presence of PIMs.

"Elderly patients receiving home health care are usually prescribed medications by a variety of physicians, and it's a great challenge for home health care nurses to deal with prescriptions from many sources," said Dr. Bao in a news release.

Still, the home health care model offers potential for improving this situation. "Having a medical professional enter an elderly patient's home is an opportunity to do a proper medication review and reconciliation," Dr. Bao said.

The study used data from the National Home and Hospice Care Survey, conducted in 2007 by the Centers for Disease Control and Prevention (CDC), which is the most recent nationally representative epidemiological survey of home health patients. The 2002 Beers Criteria, an expert-panel-generated list that itemizes 77 medications or groups of medications considered inappropriate for elderly people, was the basis for the PIMs chosen.

Researchers analyzed data of 3,124 home health patients 65 or older and found 38 percent were taking at least one PIM. Senior patients taking 15 or more medications were five to six times more likely to be prescribed PIMs as those patients taking seven or fewer medications. Of those seniors who were taking at least one PIM, 21 percent were taking 15 or more medications.

The study underestimates how often PIMS are taken by home health patients, Dr Bao said. Researchers were not able to look at potentially problematic drug-to-drug interactions or drug-and-disease interactions because data were not available.

According to the study, there is no one reason why PIMs are prevalent in home health care settings.

Many doctors are not aware of what is on the PIM list, Dr. Bao said, and few hospitals have an electronic reference for patients that lists all medications that are prescribed to a patient by various doctors. This makes it harder to share information. Improved physician communication with home health care nurses may also help to address this issue.

Dr. Bao sees incentives for improvement in communication and care coordination in the Patient Protection and Affordable Care Act, which was passed by the U.S. Congress in 2010.

"The current payment system doesn't provide incentives to optimize coordination of care," says Dr. Bao. "But when providers in different settings as a group are held responsible for outcomes and costs of care through, for example, an accountable care organization — a concept promoted in the Affordable Care Act — this could create an impetus to break the communication barriers that currently exist.”

For more on medical safety issues, see the library of articles by Daytona Beach nursing home injury attorney.

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