Deprescribing Blood Pressure Treatment in Long-Term Care Residents |
| |
| Affiliation: | 1. Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA;2. Geriatric Research, Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, USA;3. Department of Medicine, University of California San Francisco, San Francisco, CA, USA;4. Division of Geriatrics, San Francisco VA Medical Center, San Francisco, CA, USA;5. Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, USA;6. Health Economics Research Center, VA Palo Alto Health Care System, Palo Alto, CA, USA;7. Department of Pharmacy, University of Washington, Seattle, WA, USA;8. Kidney Health Research Collaborative, University of California San Francisco and San Francisco VA Medical Center, San Francisco, CA, USA;9. Cricket Health, Inc, San Francisco, CA, USA;1. Pharmacy Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain;2. School of Health Sciences Blanquerna, University Ramon Llull, Barcelona, Spain;1. Medical Director, Baltimore, MD, USA;2. Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, MD, USA;1. Department of Occupational Therapy, University of Texas Medical Branch, Galveston, TX, USA;2. Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA;3. Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, USA;4. Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA;5. Sheltering Arms Institute, 2000 Wilkes Ridge Pl Drive, Richmond, VA, USA;6. Sealy Center on Aging, University of Texas Medical Branch, TX, USA;1. King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom;2. South London and Maudsley NHS Foundation Trust, London, United Kingdom |
| |
| Abstract: | ObjectivesTo evaluate the incidence of deprescribing of antihypertensive medication among older adults residing in Veterans Affairs (VA) nursing homes for long-term care and rates of deprescribing after potentially triggering events.DesignRetrospective cohort study.Setting and ParticipantsLong-term care residents aged 65 years and older admitted to a VA nursing home from 2006 to 2019 and using blood pressure medication at admission.MethodsData were extracted from the VA electronic health record, and Centers for Medicare & Medicaid Services Minimum Data Set and Bar Code Medication Administration. Deprescribing was defined on a rolling basis as a reduction in the number or dose of antihypertensive medications, sustained for ≥2 weeks. We examined potentially triggering events for deprescribing, including low blood pressure (<90/60 mmHg), acute renal impairment (creatinine increase of 50%), electrolyte imbalance (potassium below 3.5 mEq/L, sodium decrease by 5 mEq/L), and falls.ResultsAmong 31,499 VA nursing home residents on antihypertensive medication, 70.4% had ≥1 deprescribing event (median length of stay = 6 months), and 48.7% had a net reduction in antihypertensive medications over their stay. Deprescribing events were most common in the first 4 weeks after admission and the last 4 weeks of life. Among potentially triggering events, a 50% increase in serum creatinine was associated with the greatest increase in the likelihood of deprescribing over the subsequent 4 weeks: residents with this event had a 41.7% chance of being deprescribed compared with 11.5% in those who did not (risk difference = 30.3%, P < .001). A fall in the past 30 days was associated with the smallest magnitude increased risk of deprescribing (risk difference = 3.8%, P < .001) of the events considered.Conclusions and ImplicationsDeprescribing of antihypertensive medications is common among VA nursing home residents, especially after a potential renal adverse event. |
| |
| Keywords: | Nursing home hypertension deprescribing epidemiology functional status |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
