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dc.contributor.authorMack, Deborah S.
dc.contributor.authorTjia, Jennifer
dc.contributor.authorHume, Anne L.
dc.contributor.authorLapane, Kate L.
dc.date2022-08-11T08:11:02.000
dc.date.accessioned2022-08-23T17:29:43Z
dc.date.available2022-08-23T17:29:43Z
dc.date.issued2020-02-14
dc.date.submitted2020-02-20
dc.identifier.citation<p>Mack DS, Tjia J, Hume AL, Lapane KL. Prevalent Statin Use in Long-Stay Nursing Home Residents with Life-Limiting Illness. J Am Geriatr Soc. 2020 Feb 14:10.1111/jgs.16336. doi: 10.1111/jgs.16336. Epub ahead of print. PMID: 32057091. <a href="https://doi.org/10.1111/jgs.16336">Link to article on publisher's site</a></p>
dc.identifier.issn0002-8614 (Linking)
dc.identifier.doi10.1111/jgs.16336
dc.identifier.pmid32057091
dc.identifier.urihttp://hdl.handle.net/20.500.14038/50382
dc.description.abstractOBJECTIVES: To evaluate the prevalence and factors associated with statin pharmacotherapy in long-stay nursing home residents with life-limiting illness. DESIGN: Cross-sectional. SETTING: US Medicare- and Medicaid-certified nursing home facilities. PARTICIPANTS: Long-stay nursing home resident Medicare fee-for-service beneficiaries aged 65 years or older with life-limiting illness (n = 424 212). MEASUREMENTS: Prevalent statin use was estimated as any low-moderate intensity (daily dose low-density lipoprotein-cholesterol [LDL-C] reduction < 30%-50%) and high-intensity (daily dose LDL-C reduction > 50%) use via Medicare Part D claims for a prescription supply on September 30, 2016, with a 90-day look-back period. Life-limiting illness was operationally defined to capture those near the end of life using evidence-based criteria to identify progressive terminal conditions or limited prognoses ( < 6 mo). Poisson models provided estimates of adjusted prevalence ratios and 95% confidence intervals for resident factors. RESULTS: A total of 34% of residents with life-limiting illness were prescribed statins (65-75 y = 44.0%, high intensity = 11.1%; > 75 y = 31.1%, high intensity = 5.4%). Prevalence of statins varied by life-limiting illness definition. Of those with a prognosis of less than 6 months, 23% of the 65 to 75 and 12% of the older than 75 age groups were on statins. Factors positively associated with statin use included minority race or ethnicity, use of more than five concurrent medications, and atherosclerotic cardiovascular disease or risk factors. CONCLUSION: Despite having a life-limiting illness, more than one-third of clinically compromised long-stay nursing home residents remain on statins. Although recent national guidelines have expanded indications for statins, the benefit of continued therapy in an advanced age population near the end of life is questionable. Efforts to deprescribe statins in the nursing home setting may be warranted.
dc.language.isoen_US
dc.relation<p><a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=32057091&dopt=Abstract">Link to Article in PubMed</a></p>
dc.relation.urlhttps://doi.org/10.1111/jgs.16336
dc.subjectend of life
dc.subjectnursing homes
dc.subjectpharmacotherapy
dc.subjectstatins
dc.subjectUMCCTS funding
dc.subjectGeriatrics
dc.subjectHealth Services Administration
dc.subjectPharmaceutical Preparations
dc.subjectTherapeutics
dc.subjectTranslational Medical Research
dc.titlePrevalent Statin Use in Long-Stay Nursing Home Residents with Life-Limiting Illness
dc.typeJournal Article
dc.source.journaltitleJournal of the American Geriatrics Society
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/umccts_pubs/209
dc.identifier.contextkey16603955
html.description.abstract<p>OBJECTIVES: To evaluate the prevalence and factors associated with statin pharmacotherapy in long-stay nursing home residents with life-limiting illness.</p> <p>DESIGN: Cross-sectional.</p> <p>SETTING: US Medicare- and Medicaid-certified nursing home facilities.</p> <p>PARTICIPANTS: Long-stay nursing home resident Medicare fee-for-service beneficiaries aged 65 years or older with life-limiting illness (n = 424 212).</p> <p>MEASUREMENTS: Prevalent statin use was estimated as any low-moderate intensity (daily dose low-density lipoprotein-cholesterol [LDL-C] reduction < 30%-50%) and high-intensity (daily dose LDL-C reduction > 50%) use via Medicare Part D claims for a prescription supply on September 30, 2016, with a 90-day look-back period. Life-limiting illness was operationally defined to capture those near the end of life using evidence-based criteria to identify progressive terminal conditions or limited prognoses ( < 6 mo). Poisson models provided estimates of adjusted prevalence ratios and 95% confidence intervals for resident factors.</p> <p>RESULTS: A total of 34% of residents with life-limiting illness were prescribed statins (65-75 y = 44.0%, high intensity = 11.1%; > 75 y = 31.1%, high intensity = 5.4%). Prevalence of statins varied by life-limiting illness definition. Of those with a prognosis of less than 6 months, 23% of the 65 to 75 and 12% of the older than 75 age groups were on statins. Factors positively associated with statin use included minority race or ethnicity, use of more than five concurrent medications, and atherosclerotic cardiovascular disease or risk factors.</p> <p>CONCLUSION: Despite having a life-limiting illness, more than one-third of clinically compromised long-stay nursing home residents remain on statins. Although recent national guidelines have expanded indications for statins, the benefit of continued therapy in an advanced age population near the end of life is questionable. Efforts to deprescribe statins in the nursing home setting may be warranted.</p>
dc.identifier.submissionpathumccts_pubs/209
dc.contributor.departmentMorningside Graduate School of Biomedical Sciences
dc.contributor.departmentDivision of Epidemiology, Department of Population and Quantitative Health Sciences
dc.description.thesisprogramClinical and Population Health Research


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