Visit coronavirus.gov for the latest Coronavirus Disease (COVID-19) updates.

You are here

DH-7 Data Details

Expand All

DH-7 Reduce the proportion of older adults with disabilities who use inappropriate medications

About the Data

Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

Data Source: 
Medical Expenditure Panel Survey
Changed Since the Healthy People 2020 Launch: 
Yes
Measure: 
percent
Baseline (Year): 
18.0 (2009)
Target: 
10.8
Target-Setting Method: 
Projection/trend analysis
Target-Setting Method Justification: 
Data from 2002-2009 were used to perform a trend analysis. We noted that exponential, polynomial and linear projections were valid with R-squared values approaching 1. Using the most conservative of the three projection methods, exponential projection, the target was set at 10.8 percent to be achieved by the end of the decade.
Numerator: 

Number of persons aged 65 years and over with basic activity limitations, complex activity limitations, or neither who received one or more of 33 potentially inappropriate medications during the calendar year as determined by the Beers criteria

Denominator: 

Number of persons aged 65 years and over with basic activity limitations, complex activity limitations, or neither

Comparable Healthy People 2010 Objective: 
Not applicable
Questions Used to Obtain the National Baseline Data: 

    From the 2005 Medical Expenditure Panel Survey:

    [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?

    1. Yes
    2. No
    3. Person: ___________
    4. 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 and were most recently updated in 2003.

    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.

    Individuals are considered to be adults, aged 65 and over, with activity limitations if they answered “yes” to questions in the denominator section.

Revision History

Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

Description of Changes Since the Healthy People 2020 Launch: 
This objective moved from developmental to measurable in 2014.

References

Additional resources about the objective

  1. Agency for Healthcare Research and Quality. 2007 National Healthcare Disparities Report. Rockville (MD): U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality; February 2008. AHRQ publication No. 08-0041.
  2. Medical Expenditure Panel Survey [Internet]. Washington (DC): Agency for Health Care Quality Research (AHRQ).
  3. Zhan C, Sangl J, Bierman AS, et al. Potentially inappropriate medication use in the community-dwelling elderly. Findings from the 1996 Medical Expenditure Panel Survey. JAMA. 2001;286(22):2823-29.