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Statin Discontinuation and Life‐Limiting Illness in Non–Skilled Stay Nursing Homes at Admission
Author(s) -
Mack Deborah S.,
Baek Jonggyu,
Tjia Jennifer,
Lapane Kate L.
Publication year - 2020
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.16777
Subject(s) - medicine , discontinuation , deprescribing , minimum data set , medicaid , retrospective cohort study , emergency medicine , palliative care , confidence interval , pharmacotherapy , end of life care , relative risk , nursing homes , nursing , health care , polypharmacy , economics , economic growth
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.