Potentially Harmful Medication Use and Decline in Health-Related Quality of Life among Community-Dwelling Older Adults

摘要

BackgroundSeveral scales to quantify the impact of potentially harmful medications (PHMs) have been shown to predict mortality and functional decline; however, the effect of PHMs on quality of life (QoL) has not been well-studied. ObjectiveThe aims of this study were to investigate an association between PHM use and change in health-related QoL among community-dwelling older adults, and to compare the predictive capacity of PHM scales. MethodsWe conducted a retrospective cohort study using prescription claims data and survey responses. A total of 426 community-dwelling adults aged 65?years or older who visited senior centers and had received prescriptions through a statewide prescription drug subsidy program were included. Anticholinergic Cognitive Burden (ACB), Drug Burden Index-sedative component (DBI-Se), Drug Burden Index-anticholinergic component (DBI-ACh), and the number of regular medications and Beers list medications were calculated from the claims data between baseline and 12?months. In addition, change in the EuroQoL five-dimensions questionnaire (EQ-5D) between baseline and 6- and 12-month follow-up were measured as the main outcome. A linear mixed model was used for the analysis. ResultsAfter adjusting for covariates, both DBI-Se (coefficients???0.076, 95% confidence interval [CI]???0.131 to???0.020) and DBI-Ach (coefficients???0.095, 95% CI???0.188 to???0.002) significantly predicted a decline in EQ-5D index. The ACB, number of regular medications, and number of Beers medications did not have a significant association with EQ-5D changes. ConclusionsPHM measures incorporating dose revealed a better predictive capacity for QoL change. Reducing cumulative drug dose, as well as stopping medications, would be important for the well-being of this population.