Household Wealth and Potentially Inappropriate Medications in Persons With Dementia: Role of Comorbidities and Caregivers.

BACKGROUND: The association between lower socioeconomic status and increased potentially inappropriate medications (PIMs) among older adults, as seen in some studies, is infrequently studied in persons with dementia (PWD). This association may additionally be impacted by multimorbidity and caregiver support in PWD. Thus, we examined the association between wealth and PIMs in PWD and the effects of comorbidities and caregivers.

METHODS: We included community-dwelling adults aged ≥ 66 with dementia in the Health and Retirement Study (2008-2018). PIMs included sedative-hypnotics, strongly anticholinergics, and medications from 2019 Beers and STOPP-Version 2 criteria. The primary outcome was a prescription for ≥ 1 PIM. We used logistic regression with national survey weights to examine the association between household wealth (above vs. below sample median) and ≥ 1 PIM through 4 models: (1) unadjusted, (2) adjusted for demographics (age, sex, race/ethnicity), 3) Model 2 + comorbidity count (range 0-7), (4) Model 3 + caregiver type (no caregiver, paid caregiver, unpaid caregiver only).

RESULTS: The cohort consisted of 1475 PWD (median age 84, 67% female, 15% Black, median household wealth $86,000 (IQR 2000-315,000), 49% with unpaid caregiver only, 23% with paid caregiver). Overall, 76% received ≥ 1 PIM. Adjusting for demographics, PWD with below median wealth showed increased odds of receiving ≥ 1 PIM (OR = 1.44, 95% CI = 1.07-1.93). This association was not statistically significant after adjusting for comorbidity count (OR = 1.26, 95% CI = 0.93-1.70). In a stratified analysis by comorbidity count adjusting for demographics and wealth, paid caregiver presence was associated with increased odds of PIMs among individuals with ≤ 2 chronic conditions (OR = 2.60, 95% CI = 1.44-4.69) but not with ≥ 3 chronic conditions (OR = 0.90, 95% CI = 0.50-1.62) (p = 0.02 for interaction).

CONCLUSIONS: Among PWD, the association between lower wealth and increased odds of PIMs was no longer statistically significant after adjusting for comorbidity count. Caregiving status had a complex relationship with PIMs based on comorbidity burden.