Title

Statin Discontinuation and Life-Limiting Illness in Non-Skilled Stay Nursing Homes at Admission

UMMS Affiliation

Division of Epidemiology, Department of Population and Quantitative Health Sciences; Division of Biostatistics and Health Services Research, Department of Population and Quantitative Health Sciences; Clinical and Population Health Research Program, Graduate School of Biomedical Sciences

Publication Date

2020-12-01

Document Type

Article

Disciplines

Geriatrics | Health Services Administration | Health Services Research | Pharmacy and Pharmaceutical Sciences | Translational Medical Research

Abstract

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.

Keywords

deprescribing, long-term care, nursing home, older adults, statins, UMCCTS funding

DOI of Published Version

10.1111/jgs.16777

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

Journal/Book/Conference Title

Journal of the American Geriatrics Society

Related Resources

Link to Article in PubMed

PubMed ID

33270223

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