Alireza Malek Makan1, Hein van Hout2, Graziano Onder3, Harriet Finne-Soveri4, Henriëtte van der Roest5, Rob van Marum6. 1. VU University Medical Center, Department of General Practice and Elderly Care Medicine at EMGO+ and Amsterdam Public Health Institutes, Amsterdam, The Netherlands; Nursing Home, Amaris Zorggroep, Hilversum, The Netherlands. 2. VU University Medical Center, Department of General Practice and Elderly Care Medicine at EMGO+ and Amsterdam Public Health Institutes, Amsterdam, The Netherlands. Electronic address: hpj.vanhout@vumc.nl. 3. Department of Geriatrics, Neuroscience, and Orthopedics, Agostino Gemelli University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy. 4. Department of Wellbeing, National Institute for Health and Wellbeing, Helsinki, Finland. 5. VU University Medical Center, Department of General Practice and Elderly Care Medicine at EMGO+ and Amsterdam Public Health Institutes, Amsterdam, The Netherlands. 6. VU University Medical Center, Department of General Practice and Elderly Care Medicine at EMGO+ and Amsterdam Public Health Institutes, Amsterdam, The Netherlands; Department of Geriatric Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands.
Abstract
INTRODUCTION: In nursing home (NH) residents with a very short life expectancy, the benefits of preventive cardiovascular medication maintenance are questionable. OBJECTIVE: To assess the prevalence of 4 classes of preventive cardiovascular medication (PCM) in NH residents, and to explore differences of prevalence across length of stay, mortality risk, cognitive impairment, functional disability, and across countries. METHODS: A 12-month prospective cohort study was conducted in 57 NHs in 8 countries (Czech Republic, England, Finland, France, Germany, Italy, The Netherlands, and Israel). We assessed the prevalence at first measurement of 4 classes of PCM: oral anticoagulants (OAC), platelet aggregation inhibitor (PAI), antihypertensive (AHT), and lipid-modifying agent (LMA), in older (60+ years) residents with valid medication assessments. The PCM prevalence was compared across the length of stay (short <60 days, mid, long >12 months), health instability as defined by Changes in Health, End-Stage Disease, Signs, and Symptoms Scale (CHESS) > 3, cognitive impairment by Cognitive Performance Scale (CPS) > 2, and functional disability was measured using the Activities of Daily Living Hierarchy Scale (ADLH) ≥5. RESULTS: Of the 3759 eligible residents, 2175 (57.9%) used at least 1 PCM. The prevalence of the 4 groups of PCM: OAC, PAI, AHT and LMA were 5.6%, 34.9%, 35.7%, and 10.4%, respectively. PCM use was lower in long-stay residents versus mid-stay: 56.0% vs. 62.7%, in cognitively impaired residents (47.1% vs. 67%), in residents with a high mortality risk (47.4% vs. 58.6%), and in residents with a high ADLH score (48.6% vs 64.0%). CONCLUSION: Although the prevalence of PCM use was lower in long-stay, cognitively impaired residents, persons with a high mortality risk, and residents with more functional disabilities, there seems to be room for deprescribing.
INTRODUCTION: In nursing home (NH) residents with a very short life expectancy, the benefits of preventive cardiovascular medication maintenance are questionable. OBJECTIVE: To assess the prevalence of 4 classes of preventive cardiovascular medication (PCM) in NH residents, and to explore differences of prevalence across length of stay, mortality risk, cognitive impairment, functional disability, and across countries. METHODS: A 12-month prospective cohort study was conducted in 57 NHs in 8 countries (Czech Republic, England, Finland, France, Germany, Italy, The Netherlands, and Israel). We assessed the prevalence at first measurement of 4 classes of PCM: oral anticoagulants (OAC), platelet aggregation inhibitor (PAI), antihypertensive (AHT), and lipid-modifying agent (LMA), in older (60+ years) residents with valid medication assessments. The PCM prevalence was compared across the length of stay (short <60 days, mid, long >12 months), health instability as defined by Changes in Health, End-Stage Disease, Signs, and Symptoms Scale (CHESS) > 3, cognitive impairment by Cognitive Performance Scale (CPS) > 2, and functional disability was measured using the Activities of Daily Living Hierarchy Scale (ADLH) ≥5. RESULTS: Of the 3759 eligible residents, 2175 (57.9%) used at least 1 PCM. The prevalence of the 4 groups of PCM: OAC, PAI, AHT and LMA were 5.6%, 34.9%, 35.7%, and 10.4%, respectively. PCM use was lower in long-stay residents versus mid-stay: 56.0% vs. 62.7%, in cognitively impaired residents (47.1% vs. 67%), in residents with a high mortality risk (47.4% vs. 58.6%), and in residents with a high ADLH score (48.6% vs 64.0%). CONCLUSION: Although the prevalence of PCM use was lower in long-stay, cognitively impaired residents, persons with a high mortality risk, and residents with more functional disabilities, there seems to be room for deprescribing.
Authors: Michelle Vu; Florentina E Sileanu; Sherrie L Aspinall; Joshua D Niznik; Sydney P Springer; Maria K Mor; Xinhua Zhao; Mary Ersek; Joseph T Hanlon; Walid F Gellad; Loren J Schleiden; Joshua M Thorpe; Carolyn T Thorpe Journal: J Am Med Dir Assoc Date: 2020-07-25 Impact factor: 4.669
Authors: Steffie H Brouns; Renée Brüggemann; Aimée E M J H Linkens; Fabienne J Magdelijns; Hanneke Joosten; Ron Heijnen; Arina J Ten Cate-Hoek; Jos M G A Schols; Hugo Ten Cate; Bart Spaetgens Journal: J Am Geriatr Soc Date: 2020-07-21 Impact factor: 7.538