3038 — Racial Differences in Medication Use among Older Long-Stay Veteran Nursing Home Patients

Hanlon JT (Pittsburgh VA), Good CB (Pittsburgh VA), Rossi MI (Pittsburgh VA), Stone RA (Pittsburgh VA), Semla TP (VA PBM), Cunningham FE (VA MedSafe Program)

Objectives:
The objective of this study was to examine racial differences in medication use in older long-stay VA Nursing Home Care Unit (NHCU) patients.

Methods:
This is a longitudinal study of medication use received from admission to 90 days for VA NHCU residents aged 65 years or older. The sample included veterans admitted between January 1, 2004 and June 30, 2005 to a VA NHCU. Those there for less than 90 days and receiving hospice or respite care were excluded. The data sources included VA Minimum Data Set (MDS) and Pharmacy Benefits Management (PBM) data. The primary outcomes were the prevalence of those taking 9+ medications and medications from specific therapeutic medication classes. The primary independent variable was race. Chi square testing was conducted to examine racial differences in the use of multiple medications and specific medication classes.

Results:
The sample consisted of 3,480 patients of whom 14.3% were black. Blacks compared to Whites (all comparisons p < 0.05 except where noted otherwise) were younger (13.6% vs 17.4%, 85+ years of age), had less depression (22.3% vs 29.8%), less bipolar disease (1.4% vs 3.9%), less Alzheimer’s disease (8.8% vs 12.4%), similar rate of other dementia (29.5 vs 25.8; p=0.09), more schizophrenia (13.6% vs 8.8%), more seizure disorders (8.6% vs 4.8%), more hypertension (75.8% vs 65.5%), more strokes (23.1% vs 16.7%) and more diabetes (45.5% vs 35.7%). The percent of patients taking 9+ medications at 90 days was similar by race (blacks 75.2% vs whites 73.4%; p=0.62). The prevalence of medication class use was similar by race (p > 0.05) for cardiovascular (blacks 74.4% vs whites 71.3%), oral anticoagulants (i.e., warfarin; blacks 12.4% vs whites 12.6%; p=0.26), dementia treatments (i.e., acetylcholinesterase enzyme inhibitors; blacks 15.2% vs 13.8%), and endocrine drugs (blacks 44.1% vs whites 44.8%). However, blacks were less likely than whites to take central nervous system (CNS) medications (75.8% vs 80.1%; p=0.02). Examination of subclasses of CNS medication use by race revealed no differences (p > 0.05) in antipsychotic (27.7% vs 25.8%), antiepileptic (18.2% vs 17.1%), or antidepressant use (40.7% vs 40.1%).

Implications:
There appears to be racial differences in the overall use of CNS medications but not for individual subclasses. Antidepressants are the most commonly used CNS medication, and the rate of use is nearly twice as many as those with depression. There is similar warfarin use despite blacks having a higher rate of stroke than whites.

Impacts:
This is the first study to examine medication use in older long-stay veterans in VA NHCUs (now named community living centers). Future studies should examine factors associated with suboptimal prescribing of high-use drugs (i.e., antidepressants) and high-risk drugs (i.e. warfarin) for older VA community-living center patients, as well as the impact on health outcomes (i.e., hospitalization, death, functional status decline).