Potentially inappropriate medication in homebound older adults receiving home medical care.

Aim: This study aimed to reveal demographic data for care-dependent older adults receiving home medical care and to evaluate whether potentially inappropriate medication (PIM) prescriptions were associated with hospitalization and death.

Methods: Data of health-care and long-term care insurance claims of older adults aged ≥65 years receiving home medical care of Kure City, Japan in April 2017 were obtained.　They included age, sex, recorded diagnosis on medical claims, level of long-term care (LTC) needs, and medication profile. Hospital admissions and deaths were identified between April 2017 and April 2019. Factors associated with hospitalization/death and PIM (≥1 PIM) defined by STOPP-J were analyzed statistically.

Results: A total of 2052 participants (mean age 86.5±7.4 years, female 71.7%) were included. The mean number of prescribed medications was 6.6±4.3. PIM increased as LTC level became severer (8.7% for support level 1 and 2, 22.6% for care level 1 and 2, 26.0% for care level 3 to 5). Among PIM, H2 receptor antagonists were the most common medication (29.0%), followed by antiplatelet agents (22.6%), magnesium oxide (19.4%), non-benzodiazepine sedatives (17.7%), and benzodiazepines (16.8%). On logistic regression analysis, the number of medications, PIM, and care level 1 and 2 were associated with higher likelihood of hospital admission. There was no significant correlation between each PIM and hospital admissions. Regarding death, while age was associated with higher likelihood, female gender and severer level of disability were associated with lower likelihood.

Conclusions: PIM was prevalent among homebound older adults, suggesting that careful medication review should be conducted especially in those with disability.