Statin Discontinuation and Life-Limiting Illness in Non-Skilled Stay Nursing Homes at Admission
UMass Chan Affiliations
Clinical and Population Health Research Program, Graduate School of Biomedical SciencesDivision of Biostatistics and Health Services Research, Department of Population and Quantitative Health Sciences
Division of Epidemiology, Department of Population and Quantitative Health Sciences
Document Type
Journal ArticlePublication Date
2020-12-01Keywords
deprescribinglong-term care
nursing home
older adults
statins
UMCCTS funding
Geriatrics
Health Services Administration
Health Services Research
Pharmacy and Pharmaceutical Sciences
Translational Medical Research
Metadata
Show full item recordAbstract
OBJECTIVES: To estimate 30-day statin discontinuation among newly admitted nursing home residents overall and within categories of life-limiting illness. DESIGN: Retrospective cohort using Minimum Data Set 3.0 nursing home admission assessments from 2015 to 2016 merged to Medicare administrative data files. SETTING: U.S. Medicare- and Medicaid-certified nursing home facilities (n = 13,092). PARTICIPANTS: Medicare fee-for-service beneficiaries, aged 65 years and older, newly admitted to nursing homes for non-skilled nursing facility stays on statin pharmacotherapy at the time of admission (n = 73,247). MEASUREMENTS: Residents were categorized using evidence-based criteria to identify progressive, terminal conditions or limited prognoses ( < 6 months). Discontinuation was defined as the absence of a new Medicare Part D claim for statin pharmacotherapy in the 30 days following nursing home admission. RESULTS: Overall, 19.9% discontinued statins within 30 days of nursing home admission, with rates that varied by life-limiting illness classification (no life-limiting illness: 20.5%; serious illness: 18.6%; receipt of palliative care consult: 34.5%; clinician designated as end-of-life: 45.0%). Relative to those with no life-limiting illness, risk of 30-day statin discontinuation increased with life-limiting illness severity (serious illness: adjusted risk ratio (aRR) = 1.06; 95% confidence interval (CI) = 1.02-1.10; palliative care index diagnosis: aRR = 1.15; 95% CI = 1.10-1.21; palliative care consultation: aRR = 1.58; 95% CI = 1.43-1.74; clinician designated as end of life: aRR = 1.59; 95% CI = 1.42-1.79). Nevertheless, most remained on statins after entering the nursing home regardless of life-limiting illness status. CONCLUSION: Statin use continues in a large proportion of Medicare beneficiaries after admission to a nursing home. Additional deprescribing research, which identifies how to engage nursing home residents and healthcare providers in a process to safely and effectively discontinue medications with questionable benefits, is warranted.Source
Mack DS, Baek J, Tjia J, Lapane KL. Statin Discontinuation and Life-Limiting Illness in Non-Skilled Stay Nursing Homes at Admission. J Am Geriatr Soc. 2020 Dec;68(12):2787-2796. doi: 10.1111/jgs.16777. Epub 2020 Aug 17. PMID: 33270223. Link to article on publisher's site
DOI
10.1111/jgs.16777Permanent Link to this Item
http://hdl.handle.net/20.500.14038/50409PubMed ID
33270223Related Resources
ae974a485f413a2113503eed53cd6c53
10.1111/jgs.16777