Abstract：
BACKGROUND: More than one-fourth of older adults with cognitive impairment (CI) live alone; these individuals often lack support for medication management and face a high risk of adverse drug events. We characterized the frequency and types of high-risk medications used by older adults with CI living alone and, for context, compared patterns with those in older adults with CI living with others.
METHODS: This was a cross-sectional study of National Health and Aging Trends Study (NHATS) data and Medicare claims (2015-2017). We ascertained cognitive status from NHATS and medication use with Part D claims. We compared high-risk medication use (those with adverse cognitive effects or low tolerance for misuse) among older adults with CI living alone versus living with others using logistic regression models adjusted for demographic/clinical factors.
RESULTS: The unweighted sample included 1569 older adults with CI, of whom 491 (weighted national estimate, 31%) were living alone. In the living-alone group, the mean age was 79.9 years and 66% were female, 64% reported managing medications on their own without difficulty, 14% reported managing medications on their own with difficulty, and 18% received total support with medication management. Older adults with CI living alone used a median of 5 medications (IQR, 3-8), 16% took ≥10 medications, and 46% took ≥1 high-risk medication (anticholinergic/sedating: 24%; opioid: 13%; anticoagulant: 10%; sulfonylurea: 10%; insulin: 9%). Compared with those living with others, the use of high-risk medications was similar (p > 0.05 for unadjusted/adjusted comparisons). Those living alone were more likely both to take at least one high-risk medication and not receive help with medication management: 34% in those living alone versus 23% living with others (p < 0.05 for unadjusted/adjusted comparisons).
CONCLUSIONS: Older adults with CI living alone use many medications; nearly half use high-risk medications. Our findings can inform medication optimization interventions supporting this vulnerable population.
METHODS: This was a cross-sectional study of National Health and Aging Trends Study (NHATS) data and Medicare claims (2015-2017). We ascertained cognitive status from NHATS and medication use with Part D claims. We compared high-risk medication use (those with adverse cognitive effects or low tolerance for misuse) among older adults with CI living alone versus living with others using logistic regression models adjusted for demographic/clinical factors.
RESULTS: The unweighted sample included 1569 older adults with CI, of whom 491 (weighted national estimate, 31%) were living alone. In the living-alone group, the mean age was 79.9 years and 66% were female, 64% reported managing medications on their own without difficulty, 14% reported managing medications on their own with difficulty, and 18% received total support with medication management. Older adults with CI living alone used a median of 5 medications (IQR, 3-8), 16% took ≥10 medications, and 46% took ≥1 high-risk medication (anticholinergic/sedating: 24%; opioid: 13%; anticoagulant: 10%; sulfonylurea: 10%; insulin: 9%). Compared with those living with others, the use of high-risk medications was similar (p > 0.05 for unadjusted/adjusted comparisons). Those living alone were more likely both to take at least one high-risk medication and not receive help with medication management: 34% in those living alone versus 23% living with others (p < 0.05 for unadjusted/adjusted comparisons).
CONCLUSIONS: Older adults with CI living alone use many medications; nearly half use high-risk medications. Our findings can inform medication optimization interventions supporting this vulnerable population.
摘要：
背景：有认知障碍（CI）的老年人中有超过四分之一的人独自生活；这些人通常缺乏对药物管理的支持，并且面临药物不良事件的高风险。我们描述了老年人使用的高风险药物的频率和类型，对于上下文，将模式与有CI与他人生活的老年人进行比较。
方法：这是一项关于国家健康与老龄化趋势研究（NHATS）数据和医疗保险索赔（2015-2017）的横断面研究。我们通过D部分索赔确定了NHATS和药物使用的认知状态。我们使用根据人口统计学/临床因素调整的逻辑回归模型，比较了单独居住的CI老年人与与其他人一起生活的高危药物使用（具有不良认知影响或对滥用的耐受性低）。
结果：未加权样本包括1569名患有CI的老年人，其中491人(加权国家估计，31%)独居。在独居群体中，平均年龄为79.9岁，66%为女性，64%的人报告说自己管理药物没有困难，14%的人报告说自己很难管理药物，18%的人获得了药物管理方面的总体支持.单独居住的老年人使用5种药物（IQR，3-8),16%服用了≥10种药物，46%的患者服用了≥1种高危药物(抗胆碱能药/镇静剂:24%;阿片类药物:13%;抗凝剂:10%;磺酰脲类:10%;胰岛素:9%).与那些与他人生活在一起的人相比，高危药物的使用情况相似(未校正/校正比较p>0.05).独居者更有可能服用至少一种高风险药物，而不接受药物管理方面的帮助：独居者占34％，与他人一起生活的占23％（未调整/调整比较p<0.05）。
结论：单独居住的老年人使用多种药物；近一半使用高风险药物。我们的发现可以为支持这一弱势群体的药物优化干预提供信息。
方法：这是一项关于国家健康与老龄化趋势研究（NHATS）数据和医疗保险索赔（2015-2017）的横断面研究。我们通过D部分索赔确定了NHATS和药物使用的认知状态。我们使用根据人口统计学/临床因素调整的逻辑回归模型，比较了单独居住的CI老年人与与其他人一起生活的高危药物使用（具有不良认知影响或对滥用的耐受性低）。
结果：未加权样本包括1569名患有CI的老年人，其中491人(加权国家估计，31%)独居。在独居群体中，平均年龄为79.9岁，66%为女性，64%的人报告说自己管理药物没有困难，14%的人报告说自己很难管理药物，18%的人获得了药物管理方面的总体支持.单独居住的老年人使用5种药物（IQR，3-8),16%服用了≥10种药物，46%的患者服用了≥1种高危药物(抗胆碱能药/镇静剂:24%;阿片类药物:13%;抗凝剂:10%;磺酰脲类:10%;胰岛素:9%).与那些与他人生活在一起的人相比，高危药物的使用情况相似(未校正/校正比较p>0.05).独居者更有可能服用至少一种高风险药物，而不接受药物管理方面的帮助：独居者占34％，与他人一起生活的占23％（未调整/调整比较p<0.05）。
结论：单独居住的老年人使用多种药物；近一半使用高风险药物。我们的发现可以为支持这一弱势群体的药物优化干预提供信息。
