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Objective: To examine the determinants of potentially inappropriate medication (PIM) use.Data Sources/study Setting: U.S. nationally representative data on (n = 16,588) noninstitutionalized older adults (age ≥65) with drug use from the 2006-2010 Medical Expenditure Panel Survey.Study Design: We operationalized the 2012 Beers Criteria to identify PIM use during the year, and we examined associations with individual-level characteristics hypothesized to be quality enabling or related to need complexity.Principal Findings: Almost one-third (30.9 percent) of older adults used a PIM. Multivariate results suggest that poor health status and high-PIM-risk conditions were associated with increased PIM use, while increasing age and educational attainment were associated with lower PIM use. Contrary to expectations, lack of a usual care source of care or supplemental insurance was associated with lower PIM use. Medication intensity appears to be in the pathway between both quality-enabling and need-complexity characteristics and PIM use.Conclusion: Our results suggest that physicians attempt to avoid PIM use in the oldest old but have inadequate focus on the high-PIM-risk conditions. Educational programs targeted to physician practice regarding high-PIM-risk conditions and patient literacy regarding medication use are potential responses. [ABSTRACT FROM AUTHOR]

Objectives To use the most recently available population-based data to estimate potentially inappropriate medication ( PIM) prevalence under the 2012 update of the Beers list of PIMs and to provide a benchmark from which to measure future changes. Design Retrospective cohort study using nationally representative data. Setting 2006-2010 Medical Expenditure Panel Survey ( MEPS). Participants Community-dwelling sample of U.S. older adults (N = 18,475). Measurements The updated Beers criteria were operationalized, generating a 'broad' PIM definition that incorporated form, route, or dose restrictions where clearly specified and a 'qualified' definition that applied specific exceptions where mentioned in the rationale associated with each drug category. Bivariate analyses described PIM prevalence, comparing the two operational definitions, and examined time trends. Results Of older adults with prescription medications, 42.6% had at least one medication fill that met the broad definition, with nonsteroidal anti-inflammatory drugs ( NSAIDs) having the highest prevalence (10.9%). The rate declined from 45.5% in 2006-2007 to 40.8% in 2009-2010. The categories with the largest absolute decline were NSAIDs, selected sulfonylureas, and estrogens. PIM prevalence was 30.9% using the qualified definition. Conclusion Despite the overall high use of PIMs, there has been a decline observed in recent years. Future studies should test the effect of educational and clinical interventions on changes in PIM use and outcomes. The current study results can aid in targeting these interventions. [ABSTRACT FROM AUTHOR]