Medication Management in Older Adults (DDE/DAE)

These HEDIS Measures

Potentially Harmful Drug-Disease Interactions in Older Adults assesses adults 65 years of age and older who have a specific disease or condition (chronic kidney disease, dementia, history of falls) and were dispensed a prescription for a medication that could exacerbate it. Three rates and a total rate are reported:

The percentage of older adults with a history of falls who had a dispensed prescription for antiepileptics, antipsychotics, benzodiazepines, nonbenzodiazepine hypnotics or antidepressants (SSRIs, tricyclic antidepressants and SNRIs).
The percentage of older adults with diagnosed dementia who had a dispensed prescription for antipsychotics, benzodiazepines, nonbenzodiazepine hypnotics, tricyclic antidepressants or anticholinergic agents.
The percentage of older adults with chronic kidney disease who had a prescription for Cox-2 selective NSAIDs or non-aspirin NSAIDs.

Use of High-Risk Medications in Older Adults assesses adults 67 years of age and older who had at least two dispensing events for the same high-risk medication. Two rates and a total rate are reported:

The percentage of older adults who had at least two dispensing events for high-risk medications from the same drug class where any use is inappropriate.
The percentage of older adults who had at least two dispensing events for high-risk medications to avoid, from the same drug class where use is potentially inappropriate except for specific conditions.

The Bottom Line

Prescription drug use by older adults can often result in adverse drug events that contribute to hospitalization, increased duration of illness, nursing home placement, falls and fractures. Despite widely accepted medical consensus that certain drugs increase the risk of harm to older adults,^1,2 these drugs continue to be prescribed. Because older adults are more likely to take multiple medications for multiple conditions, they are at higher risk of potentially harmful drug-disease interactions. Many older adults also access care across multiple health care providers, so there is an increased risk of harmful drug interactions due to lack of communication and coordination between providers.³ Furthermore, older adults are more likely to use medications long term, increasing their risk of physical and mental harm.⁴ Avoiding the use of high-risk drugs is an important and effective strategy for reducing medication-related problems and adverse drug events in older adults.⁵

Results – National Averages

Potentially Inappropriate Medications for Patients with Chronic Renal Failure

Year	Medicare HMO	Medicare PPO
2021	9.5	7.4
2020	9.9	7.5
2019	§	§
2018	10.8	8.0
2017	10.9	7.9

Potentially Inappropriate Medications for Patients with Dementia

Year	Medicare HMO	Medicare PPO
2021	37.8	37.2
2020	37.8	37.6
2019	§	§
2018	45.7	44.8
2017	46.7	45.8

Potentially Inappropriate Medications for Patients with Falls

Year	Medicare HMO	Medicare PPO
2021	35.2	35.2
2020	34.9	34.8
2019	§	§
2018	48.8	48.4
2017	48.1	48.4

Potentially Inappropriate Medications for Older Adults - Total

Year	Medicare HMO	Medicare PPO
2021	31.1	30.7
2020	31.4	31.0
2019	§	§
2018	41.2	40.9
2017	41.3	41.2

At Least One High-Risk Medication

Year	Medicare HMO	Medicare PPO
2018	14.6	13.5
2017	15.1	14.3

At Least Two High-Risk Medications

Year	Medicare HMO	Medicare PPO
2021	13.6	13
2020	13.1	12.6
2019	§	§
2018	9.7	9.2
2017	10.0	9.5

High-Risk Medications to Avoid Except for Appropriate Diagnosis

Year	Medicare HMO	Medicare PPO
2021	5.1	4.5

Use of High-Risk Medications in Older Adults - Total

Year	Medicare HMO	Medicare PPO
2021	17.5	16.3

§ Not available due to CMS suspension of data reporting during COVID-19 pandemic.

This State of Healthcare Quality Report classifies health plans differently than NCQA’s Quality Compass. HMO corresponds to All LOBs (excluding PPO and EPO) within Quality Compass. PPO corresponds to PPO and EPO within Quality Compass.

Figures do not account for changes in the underlying measure that could break trending. Contact Information Products via my.ncqa.org for analysis that accounts for trend breaks.

References

Fick, D.M., et al. “Updating the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults.” Arch Intern Med, 163:2716–24.
American Geriatrics Society. 2019. “American Geriatrics Society 2019 Updated AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults.” Journal of the American Geriatrics Society 67(4), 674–94. https://doi.org/10.1111/jgs.15767
Sherman, J.J., L. Davis, and K. Daniels. 2017. “Addressing the Polypharmacy Conundrum.” S. Pharmacist 42: HS-14.
Steinhagen, K.A., and M.B. Friedman. 2008. “Substance Abuse and Misuse in Older Adults.” Aging Well 3:20
Radcliff, S., J. Yue, G. Rocco, S.E. Aiello, E. Ickowicz, Z. Hurd, M.J. Samuel, and M.H. Beers. 2015. “American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults.” Journal of the American Geriatrics Society 63(11): 2227–46.

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