Table 2.
Characteristics of Nursing Home Residents and Multivariate Logistic Regression Analysis of Resident and Resident/Facility Characteristics Associated with Having Potentially Inappropriate Medication Prescriptions (PIRx).§
| Resident Model | Facility Model | Resident/Facility Model | |||||
|---|---|---|---|---|---|---|---|
| Characteristics | % of Residents | Odds Ratio | 95% C.I. | Odds Ratio | 95% C.I. | Odds Ratio | 95% C.I |
| Resident Characteristics | |||||||
| Age | |||||||
| 65–74 | 14.6 | 1.00 | (0.81, 1.34) | 1.07 | (0.83, 1.38) | ||
| 75–84 | 35.8 | 1.04 | (0.74, 1.06) | 0.93 | (0.78, 1.11) | ||
| 85 and older | 49.6 | 0.89 | (1.00, 1.00) | 1.00 | (1.00, 1.00) | ||
| Sex | |||||||
| Male | 26.2 | 1.16 | (0.96, 1.40) | 1.14 | (0.95, 1.37) | ||
| Female | 73.8 | 1.00 | (1.00, 1.00) | 1.00 | (1.00, 1.00) | ||
| Race | |||||||
| Black | 8.1 | 0.79 | (0.60, 1.05) | 0.78 | (0.59, 1.04)¥ | ||
| White/Hispanics/others | 91.9 | 1.00 | (1.00, 1.00) | 1.00 | (1.00, 1.00) | ||
| Marital status | |||||||
| Married | 17.9 | 1.10 | (0.87, 1.38) | ||||
| Not married | 82.1 | 1.00 | (1.00, 1.00) | ||||
| Living children | |||||||
| Yes | 70.6 | 1.02 | (0.86, 1.22) | ||||
| No | 29.4 | 1.00 | (1.00, 1.00) | ||||
| Education level | |||||||
| No high school degree | 54.6 | 1.02 | (0.85, 1.22) | ||||
| With high school degree | 45.4 | 1.00 | (1.00, 1.00) | ||||
| Poverty level | |||||||
| Less than poverty | 26.2 | 1.06 | (0.71, 1.57) | ||||
| 100 to <200 percent | 45.6 | 0.88 | (0.61, 1.27) | ||||
| 200 to <400 percent | 20.9 | 0.89 | (0.60, 1.31) | ||||
| 400 percent or more | 7.3 | 1.00 | (1.00, 1.00) | ||||
| Medicaid coverage | |||||||
| Yes | 71.3 | 1.39 | (1.10, 1.75)* | 1.31 | (1.09, 1.59)* | ||
| No | 28.7 | 1.00 | (1.00, 1.00) | 1.00 | (1.00, 1.00) | ||
| Admission before 1996 | |||||||
| Yes | 77.5 | 1.06 | (0.82, 1.39) | 0.99 | (0.79, 1.24) | ||
| No | 22.5 | 1.00 | (1.00, 1.00) | 1.00 | (1.00, 1.00) | ||
| Nursing home days in 1996 | |||||||
| 90 to 120 days | 4.9 | 0.87 | (0.56, 1.34) | 0.84 | (0.56, 1.25) | ||
| 121 to 200 days | 11.4 | 0.87 | (0.64, 1.17) | 0.86 | (0.65, 1.13) | ||
| 201 to 280 days | 11.6 | 1.04 | (0.75, 1.43) | 0.98 | (0.74, 1.31) | ||
| 281 to 366 days | 72.1 | 1.00 | (1.00, 1.00) | 1.00 | (1.00, 1.00) | ||
| Mental status | |||||||
| Alzheimer's disease and other dementia | 47.7 | 0.88 | (0.72, 1.06) | 0.86 | (0.71, 1.03) | ||
| Other mental disorders only | 15.1 | 1.35 | (1.04, 1.76)* | 1.40 | (1.07, 1.82)* | ||
| No mental disorder | 37.2 | 1.00 | (1.00, 1.00) | 1.00 | (1.00, 1.00) | ||
| Number of activities-of-daily-living limitations | |||||||
| 0 to 3 | 23.5 | 1.05 | (0.84, 1.32) | 1.07 | (0.85, 1.35) | ||
| 4 to 5 | 30.3 | 1.14 | (0.99, 1.40)¥ | 1.23 | (1.01, 1.49)* | ||
| 6 | 46.2 | 1.00 | (1.00, 1.00) | 1.00 | (1.00, 1.00) | ||
| Behavior problems | |||||||
| Yes | 27.7 | 1.16 | (0.98, 1.39)¥ | 1.17 | (0.98, 1.41)¥ | ||
| No | 72.3 | 1.00 | (1.00, 1.00) | 1.00 | (1.00, 1.00) | ||
| Communication problems | |||||||
| Yes | 29.7 | 0.66 | (0.55, 0.80)** | 0.69 | (0.57, 0.84)** | ||
| No | 70.3 | 1.00 | (1.00, 1.00) | 1.00 | (1.00, 1.00) | ||
| Average number of drugs per month | |||||||
| Less than 5 | 31.6 | 0.25 | (0.19, 0.31)** | 0.23 | (0.19, 0.29)** | ||
| 5 to<9 | 44.4 | 0.49 | (0.39, 0.62)** | 0.46 | (0.37, 0.56)** | ||
| 9 or more | 24.0 | 1.00 | (1.00, 1.00) | 1.00 | (1.00, 1.00) | ||
| Facility Characteristics | |||||||
| Ownership | |||||||
| For-profit | 64.6 | 1.04 | (0.86, 1.25) | ||||
| Nonprofit/Public | 35.4 | 1.00 | (1.00, 1.00) | ||||
| Type | |||||||
| Hospital-based | 7.0 | 0.86 | (0.55, 1.35) | ||||
| With multiple levels of care | 12.6 | 0.94 | (0.75, 1.19) | ||||
| With only NH beds | 80.4 | 1.00 | (1.00, 1.00) | ||||
| Certification status | |||||||
| Not federally certified | 3.3 | 2.54 | (0.34, 18.89) | ||||
| Either Medicare only or Medicaid only | 16.2 | 0.88 | (0.69, 1.14) | ||||
| Medicare and Medicaid | 80.5 | 1.00 | (1.00, 1.00) | ||||
| Accreditation status | |||||||
| Yes | 16.6 | 0.78 | (0.61, 0.99)* | 0.70 | (0.54, 0.92)* | ||
| No | 83.4 | 1.00 | (1.00, 1.00) | 1.00 | (1.00, 1.00) | ||
| Number of beds | |||||||
| 3 to 49 | 6.0 | 0.66 | (0.41, 1.05)¥ | 0.55 | (0.34, 0. 90)* | ||
| 50 to 99 | 25.1 | 0.88 | (0.68, 1.13) | 0.80 | (0.62, 1.03)¥ | ||
| 100 to 149 | 33.9 | 0.93 | (0.73, 1.18) | 0.92 | (0.73, 1.17) | ||
| 150 to 199 | 15.7 | 1.03 | (0.78, 1.37) | 0.99 | (0.74, 1.31) | ||
| 200 or more | 19.3 | 1.00 | (1.00, 1.00) | 1.00 | (1.00, 1.00) | ||
| Registered nurse (RN)-to-non-RN ratio | |||||||
| Fewer than 1 : 10 | 32.6 | ||||||
| Between 1 : 10 and 1 : 5 | 38.5 | ||||||
| Greater than 1 : 5 | 28.9 | ||||||
| Registered nurse (RN)-to-resident ratio | |||||||
| Fewer than 1 : 20 | 26.0 | 1.37 | (1.06, 1.75)* | 1.41 | (1.11, 1.78)* | ||
| Between 1 : 20 and 1 : 10 | 42.8 | 1.09 | (0.90, 1.31) | 1.11 | (0.92, 1.35) | ||
| Greater than 1 : 10 | 31.2 | 1.00 | (1.00, 1.00) | 1.00 | (1.00, 1.00) | ||
| Pharmacist onsite once a week | |||||||
| Yes | 46.2 | 0.96 | (0.81, 1.14) | ||||
| No | 53.8 | 1.00 | (1.00, 1.00) | ||||
| Psychologist or psychiatrist onsite once a week | |||||||
| Yes | 41.3 | 0.97 | (0.81, 1.15) | ||||
| No | 58.7 | 1.00 | (1.00, 1.00) | ||||
| Selected technological services offered¶ | |||||||
| 3 or 4 services | 13.7 | 0.95 | (0.72, 1.25) | ||||
| 2 services | 44.4 | 1.08 | (0.81, 1.44) | ||||
| 1 service | 32.5 | 0.95 | (0.67, 1.34) | ||||
| None | 9.4 | 1.00 | (1.00, 1.00) | ||||
| Influenza vaccination percentage | |||||||
| 90 percent and higher | 51.5 | 1.19 | (0.97, 1.46) | ||||
| 75 percent to<90 percent | 27.4 | 1.18 | (0.95, 1.48) | ||||
| Less than 75 percent | 21.1 | 1.00 | (1.00, 1.00) | ||||
| Census region | |||||||
| Northeast | 23.4 | 1.20 | (0.88, 1.63) | ||||
| Midwest | 31.8 | 1.23 | (0.92, 1.64) | ||||
| South | 32.8 | 1.18 | (0.88, 1.57) | ||||
| West | 12.0 | 1.00 | (1.00, 1.00) | ||||
| Metropolitan statistical area | |||||||
| Yes | 70.1 | 0.77 | (0.62, 0.96)* | 0.81 | (0.65, 1.01)¥ | ||
| No | 29.9 | 1.00 | (1.00, 1.00) | 1.00 | (1.00, 1.00) | ||
| Nursing home beds available# | |||||||
| 5 and fewer | 15.2 | 0.85 | (0.65, 1.11) | ||||
| >5 to 10 | 25.5 | 1.03 | (0.81, 1.32) | ||||
| >10 to 15 | 22.9 | 1.05 | (0.83, 1.33) | ||||
| >15 to 20 | 12.5 | 1.06 | (0.81, 1.38) | ||||
| More than 20 | 23.9 | 1.00 | (1.00, 1.00) | ||||
| County-level income per capita (in $1,000s) | |||||||
| Less than or equal 20 | 30.2 | 1.27 | (0.90, 1.80) | 1.31 | (0.91, 1.87) | ||
| >20 to 25 | 34.8 | 1.33 | (0.98, 1.79)¥ | 1.35 | (0.99, 1.85)¥ | ||
| >25 to 30 | 23.5 | 1.51 | (1.11, 2.05)* | 1.49 | (1.09, 2.05)* | ||
| More than 30 | 11.5 | 1.00 | (1.00, 1.00) | 1.00 | (1.00, 1.00) | ||
§
51% of all nursing home users in 1996 (n=3,372). Percentages based on weighted data.
¶
Services include ventilator care, intravenous therapy, dialysis, and tube feeding.
#
Nursing home beds available is the number of empty beds/1,000 elderly (75+ age).
¥
p<0.100;.
*
p<0.050;.
**
p<0.001.
Source: Center for Cost and Financing Studies, Agency for Healthcare Research and Quality, The National 1996 Medical Expenditure Panel Survey Nursing Home Component.