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Psychoactive medication use among older community-dwelling Americans

      Abstract

      Background

      Falls are a common and serious health issue among older Americans. A common fall risk factor is the use of psychoactive medications. There is limited recent information on the national prevalence of psychoactive medication use among older Americans.

      Objectives

      To estimate the prevalence of psychoactive medication use among community-dwelling older Americans and compare it with previous estimates from 1996.

      Methods

      The data source was the 2013 Cost and Use Data files combining Medicare claims data and survey data from the Medicare Current Beneficiary Survey, an in-person nationally representative survey of Medicare beneficiaries. Participants were included if they were 65 years of age and older, lived in the community, and had a complete year of prescription use data. Medication use was examined for 7 classes of psychoactive medications categorized by the 2015 American Geriatric Society Beers criteria as increasing fall risk. These include opioids, benzodiazepines, selective serotonin reuptake inhibitors, anticonvulsants, nonbenzodiazepine sedative hypnotics, antipsychotics, and tricyclic antidepressants. Data on participant demographic factors were also collected.

      Results

      Among the 6959 community-dwelling older adults studied, representing 33,268,104 community-dwelling Medicare beneficiaries, 53.3% used at least 1 psychoactive medication linked to falls in 2013. The most frequently used medication classes were opioids (34.9%), benzodiazepines (15.4%), selective serotonin reuptake inhibitors (14.3%), and anticonvulsants (13.3%). These estimates are considerably higher for all classes except tricyclic antidepressants than previous reports from 1996 that used the same data source. Among most psychoactive medication classes observed, women had higher usage than men.

      Conclusion

      More than half of all older Americans used at least 1 psychoactive medication in 2013. Health care providers, including pharmacists, play a vital role in managing older adults’ exposure to psychoactive medications. Medication management can optimize health and reduce older adult falls.
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      Biography

      Yara K. Haddad, PharmD, MPH, BCGP, Pharmacist Consultant, Totally Joined for Achieving Collaborative Techniques, Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA

      Biography

      Feijun Luo, PhD, Economist. Division of Research and Practice Integration, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA

      Biography

      Mamta V. Karani, PharmD, BCPS, Research Fellow, Oak Ridge Associated Universities, Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA

      Biography

      Zachary A. Marcum, PharmD, PhD, BCPS, Assistant Professor, Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, WA

      Biography

      Robin Lee, PhD, MPH, Home and Recreation Team Lead, Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA