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Assisted Living Residents Not Getting Proper Meds, Study Finds

October 18, 2004
A new study says most elderly residents of assisted-living or residential care facilities are not receiving all of the medications they need for four potentially life-threatening conditions.

The researchers said they concluded that undertreatment appears to be prevalent in retirement community/assisted living facilities. Since preserving independence is often a primary goal of care in these settings, they suggest that more attention may need to be paid to the use of treatments that have been shown to reduce long-term morbidity.

"Residential care and assisted living is a rapidly growing, long-term care setting, where medication use has not been carefully examined. We sought to determine the prevalence and predictors of non-prescribing of selected medications whose value in decreasing morbidity has been established in clinical trials," Dr. Philip D. Sloane of the University of North Carolina in Chapel Hill wrote in the Archives of Internal Medicine.

As part of a survey of a stratified random sample of 193 facilities in Florida, Maryland, New Jersey, and North Carolina, data was gathered on 2,014 residents 65 years and older. Patient characteristics and diagnoses were recorded based on medical record reviews and in-person patient assessments; all medications administered at least 4 of the previous 7 days were recorded. Data on facility characteristics were obtained by interviewing facility administrators.

The findings included:

• of 328 subjects with congestive heart failure, 204 (62.2%) were not receiving an angiotensin-converting enzyme inhibitor;
• of 172 subjects with prior myocardial infarction, 60.5% were not receiving aspirin and 76.2% were not receiving beta blockers;
• of 435 patients with history of stroke, 37.5% were not receiving an anticoagulant or antiplatelet agent; and
• of 315 patients with osteoporosis, 61.0% were not receiving calcium supplementation and 51.1% were not receiving any treatment for the condition.

Resident age, race, sex, comorbidity, cognitive status, and dependency in activities of daily living were rarely associated with nonprescribing; in contrast, facility factors -- particularly facility type and the frequency of physician visits -- were somewhat more frequently associated with nonprescribing.

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