2026-09-16 バッファロー大学（UB）
＜関連情報＞
- https://www.buffalo.edu/news/releases/2026/09/older-adults-cognitive-impairments-drugs.html
- https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.70607
認知障害のある高齢者における認知機能、潜在的に不適切な薬剤の使用、生活の質、および医療サービスの利用 Cognitive Potentially Inappropriate Medications, Quality of Life, and Healthcare Use in Older Adults With Cognitive Disorders
Haowen Hsu, Collin M. Clark, Steven Feuerstein, Robert G. Wahler, Ranjit Singh, David M. Jacobs
Journal of the American Geriatrics Society Published: 04 August 2026
DOI:https://doi.org/10.1111/jgs.70607
ABSTRACT
Background
Older adults with cognitive disorders, including dementia and mild cognitive impairment, are particularly vulnerable to adverse effects from centrally acting medications. Cognitive potentially inappropriate medications (CogPIMs), including anticholinergics, antipsychotics, benzodiazepines (BZDs), and non-benzodiazepine hypnotics (Z-drugs), may worsen well-being and increase healthcare utilization in this population. This study evaluates CogPIMs exposure and its association with health-related quality of life (HRQoL) and healthcare utilization among community-dwelling older adults with cognitive disorders.
Methods
We conducted a cross-sectional analysis of 2011–2022 Medical Expenditure Panel Survey (MEPS) data from adults aged ≥ 65 with cognitive disorders. CogPIMs exposure was defined as ≥ 1 prescription of anticholinergics, antipsychotics, BZDs, or Z-drugs. Outcomes included (1) annual prevalence of CogPIMs exposure, (2) healthcare utilization, and (3) HRQoL measured by SF-12 physical and mental component scores. Inverse probability of treatment weighting was used to adjust for confounding. Temporal trends were assessed using Joinpoint regression. Survey-weighted logistic and negative binomial regression models estimated adjusted associations.
Results
A total of 2796 older adults with cognitive disorders were identified in MEPS from 2011 to 2022, representing a weighted analytic sample of 29.7 million individuals. Overall CogPIM exposure declined from 39.3% in 2011 to 29.3% in 2022 (Annual Percentage Change: −1.9%, p < 0.01). CogPIM exposure was not associated with poor physical HRQoL but was associated with higher odds of poor mental HRQoL (adjusted Odds Ratio: 1.72 [1.31–2.25], p < 0.01). CogPIM exposure was also associated with higher rates of emergency department visits (adjusted incidence rate ratios (aIRR) = 1.41 [1.24–1.60], p < 0.01) and hospitalizations (aIRR = 1.38 [1.19–1.59], p < 0.01), but not outpatient visits (aIRR = 1.27 [0.75–1.54], p = 0.31).
Conclusions
Among community-dwelling older adults with cognitive disorders, CogPIM exposure remains common and is associated with poorer mental HRQoL and increased acute care utilization. Future longitudinal and interventional studies are needed to determine whether modifying exposure to CogPIM can improve well-being and reduce potentially preventable acute care utilization.
Summary
- Key points○Exposure to cognitive potentially inappropriate medications (CogPIMs) among older adults with cognitive disorders (dementia and mild cognitive impairment) declined significantly from 39.3% in 2011 to 29.3% in 2022, yet nearly one-third of this population remained exposed by the study’s end.
○CogPIM exposure is significantly associated with poorer mental health-related quality of life and increased rates of emergency department visits and hospitalizations.
○Given the cross-sectional design of the current study, future longitudinal and interventional studies are needed to further evaluate the causal relationship between CogPIM exposure, quality of life, and healthcare utilization, as well as to test interventions aimed at improving outcomes in this vulnerable population. - Why does this paper matter?○This study found that centrally acting medications disproportionately were associated with poorer psychological well-being and greater acute care utilization among cognitively vulnerable older adults. The findings support the importance of careful medication review at the point of care and highlight the need for longitudinal and interventional studies to determine whether targeted medication optimization strategies can improve quality of life or reduce acute care utilization in older adults with cognitive disorders.
