Cognitive Potentially Inappropriate Medications, Quality of Life, and Healthcare Use in Older Adults With Cognitive Disorders
Haowen Hsu, Collin M. Clark, Steven Feuerstein, Robert G. Wahler, Ranjit Singh, David M. JacobsABSTRACT
Background
Older adults with cognitive disorders, including dementia and mild cognitive impairment, are particularly vulnerable to adverse effects from centrally acting medications. Cognitive potentially inappropriate medications (CogPIMs), including anticholinergics, antipsychotics, benzodiazepines (BZDs), and non‐benzodiazepine hypnotics (Z‐drugs), may worsen well‐being and increase healthcare utilization in this population. This study evaluates CogPIMs exposure and its association with health‐related quality of life (HRQoL) and healthcare utilization among community‐dwelling older adults with cognitive disorders.
Methods
We conducted a cross‐sectional analysis of 2011–2022 Medical Expenditure Panel Survey (MEPS) data from adults aged ≥ 65 with cognitive disorders. CogPIMs exposure was defined as ≥ 1 prescription of anticholinergics, antipsychotics, BZDs, or Z‐drugs. Outcomes included (1) annual prevalence of CogPIMs exposure, (2) healthcare utilization, and (3) HRQoL measured by SF‐12 physical and mental component scores. Inverse probability of treatment weighting was used to adjust for confounding. Temporal trends were assessed using Joinpoint regression. Survey‐weighted logistic and negative binomial regression models estimated adjusted associations.
Results
A total of 2796 older adults with cognitive disorders were identified in MEPS from 2011 to 2022, representing a weighted analytic sample of 29.7 million individuals. Overall CogPIM exposure declined from 39.3% in 2011 to 29.3% in 2022 (Annual Percentage Change: −1.9%, p < 0.01). CogPIM exposure was not associated with poor physical HRQoL but was associated with higher odds of poor mental HRQoL (adjusted Odds Ratio: 1.72 [1.31–2.25], p < 0.01). CogPIM exposure was also associated with higher rates of emergency department visits (adjusted incidence rate ratios (aIRR) = 1.41 [1.24–1.60], p < 0.01) and hospitalizations (aIRR = 1.38 [1.19–1.59], p < 0.01), but not outpatient visits (aIRR = 1.27 [0.75–1.54], p = 0.31).
Conclusions
Among community‐dwelling older adults with cognitive disorders, CogPIM exposure remains common and is associated with poorer mental HRQoL and increased acute care utilization. Future longitudinal and interventional studies are needed to determine whether modifying exposure to CogPIM can improve well‐being and reduce potentially preventable acute care utilization.