Medication burden attributable to chronic comorbid conditions in the very old and vulnerable

Abstract

Objective Polypharmacy is common in older patients but relationships between polypharmacy and common co-morbid conditions have not been elucidated. Our goal was to determine relationships between daily oral medication use and common co-morbid disease dyads and triads using comprehensive medication and diagnostic data from a national sample of nursing homes (NH). Design Retrospective, cross-sectional study. Setting Nationally representative sample of U.S. Nursing Homes. Participants Nationally representative sample of long-term stay residents (n = 11734, 75% women) aged 65 years or older. Measurements Diagnosis and medication data were analyzed. Proportion of daily oral medication intake attributed to treatment of common two-(dyads) and three-disease (triad) combinations and “health maintenance” agents (vitamins, dietary supplements, stool softeners without related diagnoses) was determined. Results Older NH residents received slightly >8 oral medications/day with the number related to number of medical diagnoses (p < .001)) while use of Alzheimer medications was higher (p < .01). Conclusions A large fraction of daily oral medications were attributed to management of common co-morbid disease dyads and triads. Efforts to reduce polypharmacy and unwanted medication interactions could focus on regimens for common co-morbid dyads and triads in varying populations.