Graduation Date

Spring 5-7-2016

Document Type


Degree Name

Doctor of Philosophy (PhD)



First Advisor

Ann M. Berger

Second Advisor

Claudia Chaperon


Potentially inappropriate medications (PIMs) use in older adults is a significant public health concern. The use of PIMs to avoid may lead to negative outcomes such as adverse drug events. Prior conceptual analysis of PIMs use and observation of health-related factors in rural adults led to the design of this dissertation study. A sample was recruited from a population of rural community-dwelling older adults to examine the following specific aims: 1) Describe the use of PIMs to avoid, 2) Explore individual demographic characteristics (age, gender, income, education, and rural home location), health experience (comorbidity, number of medications and health providers), and health status factors (physical and mental function, sleep disturbance, sleep quality, and 24 hours sleep-wake patterns) as predictors of use of PIMs to avoid, 3) Examine individual demographic characteristics, health experience, health status, and the use of PIMs to avoid as predictors of patient-reported adverse drug events (ADEs). One-on-one reviews of all prescribed and over-the-counter medications (OTC), vitamins, and supplements were performed on participants (N=138). The 2012 Beers Criteria were used to identify and record PIMs to avoid. Data were collected on: participant’s demographics, subjective physical and mental health and sleep; objective sleep-wake patterns, and patient-reported ADEs. Almost half (49%) of the sample of rural community-dwelling older adults used both prescribed and OTC PIMs to avoid. The most frequently used PIMs to avoid taken by participants were prescribed and OTC non-steroidal anti-inflammatory drugs (33%), prescribed and OTC anticholinergic medications (28%), and prescribed short-acting benzodiazepines (18%). The use of PIMs to avoid was associated with higher number of medications taken and medical providers (both p