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Schousboe JT, Langsetmo L, Fink HA, Kado DM, Cauley JA, Taylor BC, Ensrud KE. Balancing fracture risk versus risk of mortality before fracture among women aged 80 years or older. J Am Geriatr Soc 2024; 72:1396-1407. [PMID: 38450585 PMCID: PMC11090747 DOI: 10.1111/jgs.18859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/02/2024] [Accepted: 02/11/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Most fractures occur in women aged ≥80 years but competing mortality unrelated to fracture may limit the benefit of osteoporosis drug therapy for some women in late life. Our primary aim was to develop separate prediction models for non-spine fracture (NSF) and mortality before fracture to identify subsets of women with varying fracture versus mortality risks. METHODS Separate prediction models were developed for NSF and mortality before NSF for 4895 women aged ≥80 years enrolled in the Study of Osteoporotic Fractures (SOF) or the Health Aging and Body Composition (HABC) study. Proportional hazards models modified to account for competing mortality were used to identify candidate risk factors for each outcome. Predictors associated with NSF or mortality (p < 0.2) were included in separate competing risk models to estimate the cumulative incidence of NSF and mortality before NSF during 5 years of follow-up. This process was repeated to develop separate prediction models for hip fracture and mortality before hip fracture. RESULTS Significant predictors of NSF (race, total hip BMD, grip strength, prior fracture, falls, and use of selective serotonin reuptake inhibitors, benzodiazepines, or oral/transdermal estrogen) differed from predictors of mortality before NSF (age, walking speed, multimorbidity, weight change, shrinking, smoking, self-rated health, dementia, and use of warfarin). Within nine subsets of women defined by tertiles of risk, 5-year outcomes varied from 28% NSF and 8% mortality in the high-risk NSF/low-risk mortality subset, to 9% NSF and 22% mortality in the low-risk NSF/high-risk mortality subset. Similar results were seen for predictors of hip fracture and mortality before hip fracture. CONCLUSION Considerable variation in 5-year competing mortality risk is present among women in late life with similar 5-year NSF risk. Both fracture risk and life expectancy should inform shared clinical decision-making regarding initiation or continuation of osteoporosis drug therapy for women aged ≥80 years.
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Affiliation(s)
- John T. Schousboe
- Park Nicollet Clinic and HealthPartners Institute, HealthPartners Inc., Minneapolis, MN
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN
| | - Lisa Langsetmo
- Center for Care Delivery and Outcomes Research, VA Health Care System, Minneapolis, MN
- Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Howard A. Fink
- Center for Care Delivery and Outcomes Research, VA Health Care System, Minneapolis, MN
- Department of Medicine, University of Minnesota, Minneapolis, MN
- Geriatric Research Education and Clinical Center, VA Health Care System, Minneapolis, MN
| | - Deborah M. Kado
- Department of Medicine, Stanford University, Stanford, CA
- Geriatric Research Education and Clinical Center, VA Health Care System, Palo Alto, CA
| | - Jane A. Cauley
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Brent C. Taylor
- Center for Care Delivery and Outcomes Research, VA Health Care System, Minneapolis, MN
- Department of Medicine, University of Minnesota, Minneapolis, MN
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Kristine E. Ensrud
- Center for Care Delivery and Outcomes Research, VA Health Care System, Minneapolis, MN
- Department of Medicine, University of Minnesota, Minneapolis, MN
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
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Hattori Y, Hamada S, Yamanaka T, Kidana K, Iwagami M, Sakata N, Tamiya N, Kojima T, Ogawa S, Akishita M. Drug prescribing changes in the last year of life among homebound older adults: national retrospective cohort study. BMJ Support Palliat Care 2024; 13:e1156-e1165. [PMID: 35831182 DOI: 10.1136/spcare-2022-003639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/21/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study aimed to evaluate the prescription patterns of drugs during the last year of life in homebound older adults who received home medical care. METHODS We used a nationwide claims database in Japan and selected older adults aged ≥75 years who received home medical care services from ≥12 months before their death. We evaluated medications prescribed 12 months before death (month 12), 3 months before death (month 3) and in the last month of life (month 1). We explored the factors associated with the decreased number of cardiovascular preventive drugs from month 12 to both month 3 and month 1. RESULTS A total of 118 661 participants were included, and the majority were aged ≥90 years and women. The prevalence of cardiovascular preventive drugs decreased but remained common in month 1, which included antihypertensives (34.7%), antiplatelets (15.9%), oral anticoagulants (7.6%), antidiabetic drugs (7.3%) and lipid-lowering drugs (6.1%). The relative decrease from month 12 to month 1 was the largest for lipid-lowering drugs (44.8%) and the smallest for oral anticoagulants (13.6%). Among other drugs, laxatives (enema), antiemetics, oral corticosteroids, analgesics, expectorants, bronchodilators and antibiotics showed a large relative increase. Older age, duration of home medical care services for <1 year and diagnoses of cancer, dementia and Parkinson's disease were associated with a greater likelihood of a decreased number of cardiovascular preventive drugs. CONCLUSIONS There is room for deprescribing to avoid inappropriate polypharmacy by balancing preventive and symptom management drugs in those receiving home medical care with a limited life expectancy.
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Affiliation(s)
- Yukari Hattori
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shota Hamada
- Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan
- Department of Home Care Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Takashi Yamanaka
- Department of Home Care Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kiwami Kidana
- Department of Home Care Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masao Iwagami
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Nobuo Sakata
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Nanako Tamiya
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Taro Kojima
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sumito Ogawa
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masahiro Akishita
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Kangasniemi M, Papinaho O, Moilanen T, Leino-Kilpi H, Siipi H, Suominen S, Suhonen R. Neglecting the care of older people in residential care settings: A national document analysis of complaints reported to the Finnish supervisory authority. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e1313-e1324. [PMID: 34499408 DOI: 10.1111/hsc.13538] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 06/17/2021] [Accepted: 07/23/2021] [Indexed: 06/13/2023]
Abstract
Neglecting to provide older people with the care they need in residential care settings leads to human suffering and increased service needs. Research is lacking on neglect in older people's residential care and one way to assess the key issues is to study complaints. The aim of this study was to analyse official complaints related to allegations of neglect in residential care settings caring for older people in Finland. The data covered 317 complaints that were recorded in the national database in 2018 and 2019. The analysis of the complaints yielded 2,922 observations of neglect in older people's care in residential care settings. Based on our results, most of the complaints were made by family members when the patients were alive and their motivation was to improve the care their relative received, as well as the care of others, in the residential care home. The complaints focused on neglecting clinical care, including restricting older people's movements, not providing daily activities and not paying sufficient attention to their hygiene and secretions. Other complaints included issues relating to nutrition, medication, communication and issues that compromised their privacy, respect and dignity. Nearly three of four complaints identified staffing issues in relation to neglect and most of the complaints concerned private, rather than public, residential care homes. Although the complaints only concerned a small proportion of the annual care provided, more attention should be paid to care practices that prevent neglect in residential care and to multi-level monitoring for dignified care.
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Affiliation(s)
- Mari Kangasniemi
- Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland
| | - Oili Papinaho
- Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland
- Oulu University Hospital, Oulu, Finland
| | - Tanja Moilanen
- Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland
| | - Helena Leino-Kilpi
- Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland
- Turku University Hospital, Turku, Finland
| | | | - Sakari Suominen
- Public Health, Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Riitta Suhonen
- Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland
- Welfare Division, Turku, Finland
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Francis SA, Wilson J, Yardley S. Good medicines management: From describing problems to a vision for change. Palliat Med 2022; 36:NP7-NP8. [PMID: 35156434 PMCID: PMC10943601 DOI: 10.1177/02692163221076712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sally-Anne Francis
- Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Joanne Wilson
- Royal Free Hospitals London NHS Foundation Trust, London, UK
| | - Sarah Yardley
- Marie Curie Palliative Care Research Department, University College London, London, UK
- Central and North West London NHS Foundation Trust, London, UK
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