Medication Costs and Use of Older Americans in Assisted Living Settings: a Nationally Representative Cross-Sectional Study

Lianlian Lei, Quincy M. Samus, Kali S. Thomas, Donovan T. Maust

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Assisted-living (AL) settings are an important residential care option for old and disabled Americans, but there are no national data characterizing medication use in AL. Objective: To investigate medication costs and use of older adults living in the AL settings compared to those in the community, independent living, and nursing home settings. Design: 2015 National Health and Aging Trends Study; nationally representative cross-sectional study. Paticipants: Respondents ≥ 65 years with Medicare Part D prescription drug coverage (n = 5980, representing 32.34 million older adults). Measures: Total Part D medication costs; number of 30-day prescription fills; binary indicators for overall polypharmacy (≥ 5 and ≥ 10 concurrent medications), prescription fills of opioid and psychotropic medications including antipsychotics, benzodiazepines, gabapentinoids, antidepressants, and central nervous system-active (CNS-active) polypharmacy. Results: Adjusting for demographics, the annual medication costs among AL residents, at $3890, were twice as high as those of their community-dwelling counterparts ($1932; p <.01). All medication outcomes except opioids were higher for older adults in AL compared to community settings. While the adjusted number of 30-day prescription fills among AL residents was slightly lower than that of nursing home residents (89.5 vs. 106.2; p <.05), AL residents experienced equivalent rates of overall polypharmacy ≥ 10 medications (30.2% vs. 23.5%), antipsychotics (30.8% vs. 27.8%), benzodiazepines (30.7% vs. 32.6%), gabapentinoids (21.2% vs. 16.1%), and CNS-active polypharmacy (26.0% vs. 36.9%; p >.05 for all). Patterns of use across settings were consistent when limited to older adults with dementia. Conclusions: Older Americans in AL experience a prescription medication burden similar to those in nursing homes. AL settings have an important opportunity to ensure their medication-related clinical services and supports match the needs of their residents.

Original languageEnglish (US)
Pages (from-to)294-301
Number of pages8
JournalJournal of general internal medicine
Volume38
Issue number2
DOIs
StatePublished - Feb 2023

Keywords

  • antipsychotics
  • assisted living
  • dementia
  • medication use
  • polypharmacy

ASJC Scopus subject areas

  • Internal Medicine

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