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U.S. Department of Health and Human Services Office of Disease Prevention and Health Promotion

Reduce the proportion of older adults who use inappropriate medications — OA‑02 Data Methodology and Measurement

On this page:  About the National Data  |  Methodology  |  History

About the National Data

Data

Data Source:  Medical Expenditure Panel (MEPS), AHRQ

Baseline: 15.9 percent of adults aged 65 years and over used inappropriate medications in 2015

Target: 11.2 percent

Numerator
Number of adults aged 65 years and over with basic activity limitations, complex activity limitations, or neither who received 1 or more of 33 potentially inappropriate medications during the calendar year as determined by the Beers criteria.
Denominator
Number of adults aged 65 years and over with basic activity limitations, complex activity limitations, or neither.
Target-setting method
Projection
Target-setting method details
Linear trend fitted using weighted least squares and a projection at the 50 percent prediction interval.
1
Target-setting method justification
Trend data were evaluated for this objective. Using historical data points, a trend line was fitted using weighted least squares, and the trend was projected into the next decade. This method was used because three or more comparable data points were available, the projected value was within the range of possible values, and a projection at the 50 percent prediction interval was selected because no additional information could be used to assess the trend line, so the target was based on the projection.

Methodology

Questions used to obtain the national baseline data

(For additional information, please visit the data source page linked above.)
Numerator:
[Medical Provider Visits Section of MEPS]:
During this {visit/telephone call}, were any medicines prescribed for (PERSON)? Please include only prescriptions which were filled.
  1. Yes
  2. No
Please tell me the names of the prescriptions from these visits that were filled.
_____________________
[Prescribed Medicines Section of MEPS]:
{Since (START DATE)/Between (START DATE) and (END DATE)}, (have/has) (PERSON) obtained any medicines [we have not yet talked about]? For example, (have/has) (PERSON) had any new prescriptions or a refill of a prescription? Please include any on-line prescriptions.
  1. Yes
  2. No
What were the names of these medicines?
_______________________

{Since (START DATE)/Between (START DATE) and (END DATE)}, did (PERSON) get any free samples of prescribed medicines from a medical or dental provider that we have not yet talked about?

  1. Yes
  2. No
What are the names of these medicines (PERSON) got as free samples?
_____________________

What is the name of the (next) pharmacy that filled the prescription(s) for (PERSON)?
_____________________

[Survey participants are then asked for permission to collect more detailed information from their pharmacies. At the pharmacies, data are collected on the type, dosage, and payment for each filled prescription. No information is collected for over-the-counter medications. No information is collected for prescription drugs obtained during hospital visits.]

Numerator and Denominator:

{Basic activity limitations identifiers}

Does anyone in the family have difficulties walking, climbing stairs, grasping objects, reaching overhead, lifting, bending or stooping, or standing for long periods of time?

  1. Yes
  2. No
Please look at this card and tell me how much difficulty (do/does) (PERSON) have lifting something as heavy as 10 pounds, such as a full bag of groceries? Would you say no difficulty, some difficulty, a lot of difficulty, or completely unable to do it?
  1. No difficulty
  2. Some difficulty
  3. A lot of difficulty
  4. Completely unable to do it
How much difficulty (do/does) (PERSON) have walking up 10 steps without resting?
  1. No difficulty
  2. Some difficulty
  3. A lot of difficulty
  4. Completely unable to do it
How much difficulty (do/does) (PERSON) have walking about 3 city blocks or about a quarter of a mile?
  1. No difficulty
  2. Some difficulty
  3. A lot of difficulty
  4. Completely unable to do it
How much difficulty (do/does) (PERSON) have walking a mile?
  1. No difficulty
  2. Some difficulty
  3. A lot of difficulty
  4. Completely unable to do it
How much difficulty (do/does) (PERSON) have standing for about 20 minutes?
  1. No difficulty
  2. Some difficulty
  3. A lot of difficulty
  4. Completely unable to do it
How much difficulty (do/does) (PERSON) have bending down or stooping from a standing position to pick up an object from the floor or tie a shoe?
  1. No difficulty
  2. Some difficulty
  3. A lot of difficulty
  4. Completely unable to do it
How much difficulty (do/does) (PERSON) have reaching overhead, for example to remove something from a shelf?
  1. No difficulty
  2. Some difficulty
  3. A lot of difficulty
  4. Completely unable to do it
How much difficulty (do/does) (PERSON) have using fingers to grasp or handle something such as picking up a glass from a table or using a pencil to write?
  1. No difficulty
  2. Some difficulty
  3. A lot of difficulty
  4. Completely unable to do it

The next few questions are about difficulties people may have with everyday activities such as getting around, bathing, or taking medications. We are interested in difficulties due to impairment or a physical or mental health problem.

Does anyone in the family receive help or supervision using the telephone, paying bills, taking medications, preparing light meals, doing laundry, or going shopping?

  1. Yes
  2. No
Does anyone in the family receive help or supervision with personal care such as bathing, dressing, or getting around the house? Who is that?
  1. Yes
  2. No
  3. Person: ___________
Does anyone in the family wear eyeglasses or contact lenses? Who is that?
  1. Yes
  2. No
  3. Person: ___________
Does anyone in the family have any difficulty seeing {with glasses or contacts, if they use them}? Who is that?
  1. Yes
  2. No
  3. Person: ___________
[For persons identified as having difficulty seeing]: Can (PERSON) not see anything at all, that is, (are/is) (PERSON) blind?
  1. Yes
  2. No
Does anyone in the family have a hearing aid? Who is that?
  1. Yes
  2. No
  3. Person: ___________
Does anyone in the family have any difficulty hearing {with a hearing aid if they use one}? Who is that?
  1. Yes
  2. No
  3. Person: ___________

[For persons identified as having difficulty hearing {with a hearing aid, if they use one}]:

Can (PERSON) not hear any speech at all, that is, (are/is) (PERSON) deaf?

  1. Yes
  2. No

{Complex activity limitations identifiers}

Is anyone in the family limited in any way in the ability to work at a job, do housework, or go to school, because of impairment or a physical or mental health problem? Who is that? For which activities is the person limited in doing?

    Yes
  1. No
  2. Person: ___________
  3. Activity: ___________
Besides the limitations we just talked about, is anyone in the family limited in participating in social, recreational or family activities because of impairment or a physical or mental health problem?
  1. Yes
  2. No

Methodology notes

The Beers criteria provide a list of medications that are generally considered inappropriate when given to elderly people because these medications may pose more risk than benefit. For a wide variety of individual reasons, the medications listed tend to cause side effects in the elderly due to the physiologic changes of aging. The criteria were created through consensus of a panel of experts. According to the established Beers criteria, drugs that should always be avoided for adults over age 65 include barbiturates, flurazepam, meprobamate, chlorpropamide, meperidine, pentazocine, trimethobenzamide, belladonna alkaloids, dicyclomine, hyoscyamine, and propantheline. Drugs that should often be avoided for adults over age 65 include carisoprodol, chlorzoxazone, cyclobenzaprine, metaxalone, methocarbamol, amitriptyline, chlordiazepoxide, diazepam, doxepin, indomethacin, dipyridamole, ticlopidine, methyldopa, reserpine, disopyramide, oxybutynin, chlorpheniramine, cyproheptadine, diphenhydramine, hydroxyzine, promethazine, and propoxyphene. Individuals are considered to receive inappropriate medications if they indicate that they purchased any of the medications on the Beers list as listed in the numerator section.

History

Comparable HP2020 objective
Modified, which includes core objectives that are continuing from Healthy People 2020 but underwent a change in measurement.
Changes between HP2020 and HP2030
This objective differs from Healthy People 2020 objective DH-7 in that DH-7 tracked older adults with activity limitations who used inappropriate medications while this objective tracks all older adults who use inappropriate medications.

1. Because Healthy People 2030 objectives have a desired direction (e.g., increase or decrease), the confidence level of a one-sided prediction interval can be used as an indication of how likely a target will be to achieve based on the historical data and fitted trend.