Deprescribing in Nursing Home Residents on Polypharmacy: Incidence and Associated Factors

Graziano Onder, Davide L. Vetrano, Emanuele R. Villani, Angelo Carfì, Maria Rita Lo Monaco, Maria Camilla Cipriani, Ester Manes Gravina, Michael Denkinger, Francesco Pagano, Henriëtte G. van der Roest, Roberto Bernabei

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Objectives: To assess 1-year incidence and factors related to deprescribing in nursing home (NH) residents in Europe. Design: Longitudinal multicenter cohort study based on data from the Services and Health for Elderly in Long TERm care (SHELTER) study. Setting: NHs in Europe and Israel. Participants: 1843 NH residents on polypharmacy. Methods: Polypharmacy was defined as the concurrent use of 5 or more medications. Deprescribing was defined as a reduction in the number of medications used over the study period. Residents were followed for 12 months. Results: Residents in the study sample were using a mean number of 8.6 (standard deviation 2.9) medications at the baseline assessment. Deprescribing was observed in 658 residents (35.7%). Cognitive impairment (mild/moderate impairment vs intact, odds ratio [OR] 1.41, 95% confidence interval [CI] 1.11-1.79; severe impairment vs intact, OR 1.60, 95% CI 1.23-2.09), presence of the geriatrician within the facility staff (OR 1.41, 95% CI 1.15-1.72), and number of medications used at baseline (OR 1.10, 95% CI 1.06-1.14) were associated with higher probabilities of deprescribing. In contrast, female gender (OR 0.76, 95% CI 0.61-0.96), heart failure (OR 0.69, 95% CI 0.53-0.89), and cancer (OR 0.64, 95% CI 0.45-0.90) were associated with a lower probability of deprescribing. Conclusions and Implications: Deprescribing is common in NH residents on polypharmacy, and it is associated with individual and organizational factors. More evidence is needed on deprescribing, and clear strategies on how to withdraw medications should be defined in the future.
Original languageEnglish
JournalJournal of the American Medical Directors Association
DOIs
Publication statusPublished - 2019

Cite this

Onder, Graziano ; Vetrano, Davide L. ; Villani, Emanuele R. ; Carfì, Angelo ; Lo Monaco, Maria Rita ; Cipriani, Maria Camilla ; Manes Gravina, Ester ; Denkinger, Michael ; Pagano, Francesco ; van der Roest, Henriëtte G. ; Bernabei, Roberto. / Deprescribing in Nursing Home Residents on Polypharmacy: Incidence and Associated Factors. In: Journal of the American Medical Directors Association. 2019.
@article{bf78b214600040c5af89bbbf3a42686e,
title = "Deprescribing in Nursing Home Residents on Polypharmacy: Incidence and Associated Factors",
abstract = "Objectives: To assess 1-year incidence and factors related to deprescribing in nursing home (NH) residents in Europe. Design: Longitudinal multicenter cohort study based on data from the Services and Health for Elderly in Long TERm care (SHELTER) study. Setting: NHs in Europe and Israel. Participants: 1843 NH residents on polypharmacy. Methods: Polypharmacy was defined as the concurrent use of 5 or more medications. Deprescribing was defined as a reduction in the number of medications used over the study period. Residents were followed for 12 months. Results: Residents in the study sample were using a mean number of 8.6 (standard deviation 2.9) medications at the baseline assessment. Deprescribing was observed in 658 residents (35.7{\%}). Cognitive impairment (mild/moderate impairment vs intact, odds ratio [OR] 1.41, 95{\%} confidence interval [CI] 1.11-1.79; severe impairment vs intact, OR 1.60, 95{\%} CI 1.23-2.09), presence of the geriatrician within the facility staff (OR 1.41, 95{\%} CI 1.15-1.72), and number of medications used at baseline (OR 1.10, 95{\%} CI 1.06-1.14) were associated with higher probabilities of deprescribing. In contrast, female gender (OR 0.76, 95{\%} CI 0.61-0.96), heart failure (OR 0.69, 95{\%} CI 0.53-0.89), and cancer (OR 0.64, 95{\%} CI 0.45-0.90) were associated with a lower probability of deprescribing. Conclusions and Implications: Deprescribing is common in NH residents on polypharmacy, and it is associated with individual and organizational factors. More evidence is needed on deprescribing, and clear strategies on how to withdraw medications should be defined in the future.",
author = "Graziano Onder and Vetrano, {Davide L.} and Villani, {Emanuele R.} and Angelo Carf{\`i} and {Lo Monaco}, {Maria Rita} and Cipriani, {Maria Camilla} and {Manes Gravina}, Ester and Michael Denkinger and Francesco Pagano and {van der Roest}, {Henri{\"e}tte G.} and Roberto Bernabei",
year = "2019",
doi = "10.1016/j.jamda.2019.01.130",
language = "English",
journal = "Journal of the American Medical Directors Association",
issn = "1525-8610",
publisher = "Elsevier Inc.",

}

Onder, G, Vetrano, DL, Villani, ER, Carfì, A, Lo Monaco, MR, Cipriani, MC, Manes Gravina, E, Denkinger, M, Pagano, F, van der Roest, HG & Bernabei, R 2019, 'Deprescribing in Nursing Home Residents on Polypharmacy: Incidence and Associated Factors' Journal of the American Medical Directors Association. https://doi.org/10.1016/j.jamda.2019.01.130

Deprescribing in Nursing Home Residents on Polypharmacy: Incidence and Associated Factors. / Onder, Graziano; Vetrano, Davide L.; Villani, Emanuele R.; Carfì, Angelo; Lo Monaco, Maria Rita; Cipriani, Maria Camilla; Manes Gravina, Ester; Denkinger, Michael; Pagano, Francesco; van der Roest, Henriëtte G.; Bernabei, Roberto.

In: Journal of the American Medical Directors Association, 2019.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Deprescribing in Nursing Home Residents on Polypharmacy: Incidence and Associated Factors

AU - Onder, Graziano

AU - Vetrano, Davide L.

AU - Villani, Emanuele R.

AU - Carfì, Angelo

AU - Lo Monaco, Maria Rita

AU - Cipriani, Maria Camilla

AU - Manes Gravina, Ester

AU - Denkinger, Michael

AU - Pagano, Francesco

AU - van der Roest, Henriëtte G.

AU - Bernabei, Roberto

PY - 2019

Y1 - 2019

N2 - Objectives: To assess 1-year incidence and factors related to deprescribing in nursing home (NH) residents in Europe. Design: Longitudinal multicenter cohort study based on data from the Services and Health for Elderly in Long TERm care (SHELTER) study. Setting: NHs in Europe and Israel. Participants: 1843 NH residents on polypharmacy. Methods: Polypharmacy was defined as the concurrent use of 5 or more medications. Deprescribing was defined as a reduction in the number of medications used over the study period. Residents were followed for 12 months. Results: Residents in the study sample were using a mean number of 8.6 (standard deviation 2.9) medications at the baseline assessment. Deprescribing was observed in 658 residents (35.7%). Cognitive impairment (mild/moderate impairment vs intact, odds ratio [OR] 1.41, 95% confidence interval [CI] 1.11-1.79; severe impairment vs intact, OR 1.60, 95% CI 1.23-2.09), presence of the geriatrician within the facility staff (OR 1.41, 95% CI 1.15-1.72), and number of medications used at baseline (OR 1.10, 95% CI 1.06-1.14) were associated with higher probabilities of deprescribing. In contrast, female gender (OR 0.76, 95% CI 0.61-0.96), heart failure (OR 0.69, 95% CI 0.53-0.89), and cancer (OR 0.64, 95% CI 0.45-0.90) were associated with a lower probability of deprescribing. Conclusions and Implications: Deprescribing is common in NH residents on polypharmacy, and it is associated with individual and organizational factors. More evidence is needed on deprescribing, and clear strategies on how to withdraw medications should be defined in the future.

AB - Objectives: To assess 1-year incidence and factors related to deprescribing in nursing home (NH) residents in Europe. Design: Longitudinal multicenter cohort study based on data from the Services and Health for Elderly in Long TERm care (SHELTER) study. Setting: NHs in Europe and Israel. Participants: 1843 NH residents on polypharmacy. Methods: Polypharmacy was defined as the concurrent use of 5 or more medications. Deprescribing was defined as a reduction in the number of medications used over the study period. Residents were followed for 12 months. Results: Residents in the study sample were using a mean number of 8.6 (standard deviation 2.9) medications at the baseline assessment. Deprescribing was observed in 658 residents (35.7%). Cognitive impairment (mild/moderate impairment vs intact, odds ratio [OR] 1.41, 95% confidence interval [CI] 1.11-1.79; severe impairment vs intact, OR 1.60, 95% CI 1.23-2.09), presence of the geriatrician within the facility staff (OR 1.41, 95% CI 1.15-1.72), and number of medications used at baseline (OR 1.10, 95% CI 1.06-1.14) were associated with higher probabilities of deprescribing. In contrast, female gender (OR 0.76, 95% CI 0.61-0.96), heart failure (OR 0.69, 95% CI 0.53-0.89), and cancer (OR 0.64, 95% CI 0.45-0.90) were associated with a lower probability of deprescribing. Conclusions and Implications: Deprescribing is common in NH residents on polypharmacy, and it is associated with individual and organizational factors. More evidence is needed on deprescribing, and clear strategies on how to withdraw medications should be defined in the future.

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UR - https://www.ncbi.nlm.nih.gov/pubmed/30853425

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DO - 10.1016/j.jamda.2019.01.130

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JO - Journal of the American Medical Directors Association

JF - Journal of the American Medical Directors Association

SN - 1525-8610

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