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Cognitive Impairment and Medication Complexity in Community-Living Older Adults: The Health, Aging and Body Composition Study

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https://ir.library.oregonstate.edu/concern/articles/bz60cx32n

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  • Background: Medication complexity is a large determinant of adherence. Few studies have explored the relationship between cognitive impairment and medication complexity. Objective: To evaluate whether cognitive impairment is associated with medication complexity for prescription and over-the-counter (OTC) medications. Methods: In this cross-sectional analysis, we studied the association between cognitive impairment and the complexity of prescriptions and OTC drug regimens. Baseline participants were from the Health, Aging and Body Composition study, consisting of 3,075 well-functioning 70 to 79 year old black and white men and women. Cognitive impairment was defined by having a Modified Mini-Mental State Examination score <80. The complexity of prescription and OTC (including supplements/herbals) medications was assessed using a modified version of the Medication Regimen Complexity Index (mMRCI). The mMRCI score increases with complexity of dosage forms, number of medications, pill burden, and non-daily dosing. Results: The mean (SD) age was 74 (2.9) years old (n=3,055; 52% female, 41% black). The median prescription mMRCI score was 6 (range: 0-66). The median OTC mMRCI score was 4 (range: 0-71). Adjusting for health status, demographics, and access to care, medication complexity was lower in participants with cognitive impairment for prescription (adjusted RR 0.89; 95% CI 0.80 to 0.99) and OTC medications (adjusted RR 0.76; 95% CI, 0.64 to 0.93) compared to those without cognitive impairment. The number of prescription medications was not different, but the number of OTC drugs was lower for those with cognitive impairment. Conclusions: In this cohort of well-functioning older adults, those with cognitive impairment had lower prescription complexity due to less-complex dosage forms, pill burden, or daily dosing. OTC complexity was also lower, primarily due to a lower number of OTC drugs. The results of this study show that further research on medication complexity and adherence and health outcomes in cognitively impaired individuals is warranted.
  • Keywords: Prescription complexity, Over-the-counter complexity, Medication complexity, Cognitive impairment
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  • Lee, D. S., de Rekeneire, N., Hanlon, J. T., Gill, T. M., Bauer, D. C., Meibohm, B., ... & Jeffery, S. M. (2012). Cognitive Impairment and Medication Complexity in Community-Living Older Adults: The Health, Aging and Body Composition Study. The Journal of Pharmacy Technology, 28(4), 156-162. doi:10.1177/875512251202800405
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  • 28
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  • 4
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  • This research was supported in part by the Intramural Research Program of the NIH, National Institute on Aging (N01-AG-6-2101; N01-AG-6-2103; N01-AG-6-2106).Dr Lee is supported by training grant T32AG019134 from the National Institute on Aging and a grant from the American Society for Clinical Pharmacology and Therapeutics.The study was conducted at the Yale Claude D. Pepper Older Americans Independence Center (P30AG21342).Dr. Gill is the recipient of a Midcareer Investigator Award in Patient-Oriented Research (K24AG021507) from the National Institute on Aging.Dr Hanlon received support from National Institute of Aging grants (P30AG024827, T32 AG021885, K07AG033174, R01AG034056, 3U01 AG012553, 2R56AG027017), a National Institute of Mental Health grant (R34 MH082682), a National Institute of Nursing Research grant (R01 NR010135), and Agency for Healthcare Research and Quality grants (R01 HS017695, R01 HS018721, K12 HS019461).
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