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Impact of Inappropriate Drug Use on Mortality and Functional Status in Representative Community Dwelling Elders

Hanlon, Joseph T. PharmD, MS*,†,¶; Fillenbaum, Gerda G. PhD∥,#; Kuchibhatla, Maggie PhD#,**; Artz, Margaret B. PhD*; Boult, Chad MD, MPH, MBA; Gross, Cynthia R. PhD*,§; Garrard, Judith PhD*,†; Schmader, Kenneth E. MD#,††,‡‡


Background. The predictive validity of Drug Utilization Review (DUR) and drugs-to-avoid criteria in elders is unknown.

Objectives. To evaluate the relationship between use of inappropriate drugs as determined by these explicit criteria and mortality and decline in functional status in community dwelling elders.

Research Design. Cohort study.

Subjects. The fourth wave (3234 participants) of the Duke Established Populations for Epidemiologic Studies of the Elderly.

Measures. Two sets of inappropriate drug-use criteria: (1) DUR with respect to dosage, duplication, drug-drug interactions, duration, and drug-disease interactions; and (2) Beers-modified criteria regarding drugs-to-avoid were applied to drug use reported in an in-home interview. Death was identified from the National Death Index; change in four functional status measures (basic self-care, intermediate self-care, complex self-management, physical function) was determined during the following 3 years.

Results. Use of inappropriate drugs identified by either set of criteria was not significantly associated with mortality. The drugs-to-avoid criteria identified no significant associations between use of these drugs and decline in functional status. With DUR criteria, however, the association between use of inappropriate drugs and basic self-care was significant and pronounced among those with drug-drug or drug-disease interaction problems (Adj. OR 2.04; 95% CI 1.32-3.16).

Conclusions. Identifying the impact of inappropriate drug use may depend on the criteria applied. Further studies are needed that measure additional outcomes and use alternate measures of inappropriate drug use.

*From the Department of Experimental and Clinical Pharmacology, College of Pharmacy; the †Division of Health Services Research and Policy, School of Public Health; and the §School of Nursing, University of Minnesota, Minneapolis, Minnesota.

From the Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.

From the Geriatric Research, Education and Clinical Center, Veterans Affairs Medical Center, Minneapolis, Minnesota.

From the ∥Department of Psychiatry and Behavioral Sciences; the #Center for the Study of Aging and Human Development; the **Department of Biostatistics and Bioinformatics; and the ††Department of Medicine, Division of Geriatrics, Duke University Medical Center, Durham, North Carolina.

‡‡From the Geriatric Research, Education and Clinical Center, Veterans Affairs Medical Center, Durham, North Carolina.

Supported by grants from the National Institute on Aging (R01-AG-15432 and R01-AG-14158) and from the VFW Endowed Chair in Pharmacotherapy for the Elderly, College of Pharmacy, University of Minnesota (Dr. Hanlon).

The data upon which this publication was based was obtained pursuant to Contract Number N01-AG-1 to 2102 from the National Institute on Aging in support of the Established Populations for Epidemiologic Studies of the Elderly (Duke). The context of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services.

Address correspondence and reprint requests to: Dr. Hanlon, the Institute for the Study of Geriatric Pharmacotherapy, College of Pharmacy, 7-115 Weaver-Densford Hall, University of Minnesota, 308 Harvard Street SE, Minneapolis, MN 55455. E-mail:

Received July 10, 2001; initial review July 20, 2001; accepted October 18, 2002.

© 2002 Lippincott Williams & Wilkins, Inc.