Intensity of Use and Regional Variation in Fracture-Associated Prescription Drug Use and Hip Fractures in Long-Term Care

<p>Among older adults, common efforts to assess polypharmacy (multiple medications) often focus on simple drug count. Our past work exploring receipt of fracture-associated drugs (FADs) and fractures suggests specific drug combinations may matter more than absolute drug count. To extend this previous work, we measure FAD and concurrent FAD receipt for a population particularly vulnerable to adverse drug effects—elderly living in long-term care (LTC). We quantify FAD exposure in this population and compare it with the community-dwelling population to begin exploring an important potentially avoidable risk. We demonstrated that intensity of FAD exposure in LTC is twice that of community-dwelling Medicare beneficiaries.(JGIM 2020) </p>
<p>To advance knowledge of the impact of intense prescribing as potential iatrogenic risk, we explore regional variation of prescription drug use intensity and its association with hip fracture rates among LTC residents. We examined intensity of prescription use categorized as total, or FAD and non-FAD in LTC beneficiaries across Hospital Referral Regions (HRRs), and we assess the association between this intensity and hip fracture rates. Among Medicare beneficiaries, FAD use in LTC setting varies substantially across US regions, and higher use is associated with hip fracture risk. These findings should prompt exploration of the drivers of both high and low intensity prescribing and should inform development of interventions aimed at maximizing prescribing quality and minimizing harm potentially conferred by FADs.(JGIM 2021)</p>