Statin Discontinuation and Life-Limiting Illness in Non-Skilled Stay Nursing Homes at Admission
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
Geriatrics | Health Services Administration | Health Services Research | Pharmacy and Pharmaceutical Sciences | Translational Medical Research
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.
deprescribing, long-term care, nursing home, older adults, statins, UMCCTS funding
DOI of Published Version
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 of the American Geriatrics Society
Mack DS, Baek J, Tjia J, Lapane KL. (2020). Statin Discontinuation and Life-Limiting Illness in Non-Skilled Stay Nursing Homes at Admission. UMass Center for Clinical and Translational Science Supported Publications. https://doi.org/10.1111/jgs.16777. Retrieved from https://escholarship.umassmed.edu/umccts_pubs/233