One-year survival and admission to hospital for cardiovascular events among older residents of long-term care facilities who were prescribed intensive- and moderate-dose statins

Background: Falls are leading cause of injury among older people, especially for those living in long-term care facilities (LTCFs). Very few studies have assessed the effect of sleep quality and hypnotics use on falls, especially in Chinese LTCFs. The study aimed to examine the association between sleep quality, hypnotics use, and falls in institutionalized older people. Methods: We recruited 605 residents from 25 LTCFs in central Shanghai and conducted a baseline survey for sleep quality and hypnotics use, as well as a one-year follow-up survey for falls and injurious falls. Logistic regression models were applied in univariate and multivariate analysis. Results: Among the 605 participants (70.41% women, mean age 84.33 ± 6.90 years), the one-year incidence of falls and injurious falls was 21.82% and 15.21%, respectively. Insomnia (19.83%) and hypnotics use (14.21%) were prevalent. After adjusting for potential confounders, we found that insomnia was significantly associated with an increased risk of falls (adjusted risk ratio (RR): 1.787, 95% CI, 1.106–2.877) and the use of benzodiazepines significantly increased the risk of injurious falls (RR: 3.128, 95% CI, 1.541–6.350). Conclusion: In elderly LTCF residents, both insomnia and benzodiazepine use are associated with an increased risk of falls and injuries. Adopting non-pharmacological approaches to improve sleep quality, taking safer hypnotics, or strengthening supervision on benzodiazepine users may be useful in fall prevention.

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[PP.03.10] MORTALITY RISK AMONG DISABLED ELDERLY RESIDENTS OF LONG TERM CARE FACILITIES DURING ONE YEAR FOLLOW-UP

Journal of Hypertension ◽

10.1097/01.hjh.0000523270.08560.bd ◽

2017 ◽

Vol 35 ◽

pp. e110

Author(s):

B. Gryglewska ◽

A. Kantoch ◽

J. Wojkowska-Mach ◽

P. Heczko ◽

T. Grodzicki

Keyword(s):

Mortality Risk ◽

Long Term Care ◽

Term Care ◽

Disabled Elderly ◽

Care Facilities ◽

One Year

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Hospice use and one-year survivorship of residents in long-term care facilities in Canada: a cohort study

BMC Palliative Care ◽

10.1186/s12904-019-0480-z ◽

2019 ◽

Vol 18 (1) ◽

Cited By ~ 3

Author(s):

Beibei Xiong ◽

Shannon Freeman ◽

Davina Banner ◽

Lina Spirgiene

Keyword(s):

Cohort Study ◽

Long Term Care ◽

Hospice Care ◽

Lower Percentage ◽

Term Care ◽

Care Facilities ◽

Diagnosis Of Dementia ◽

One Year ◽

Hospice Use

Abstract Background Hospice care is designed for persons in the final phase of a terminal illness. However, hospice care is not used appropriately. Some persons who do not meet the hospice eligibility receive hospice care, while many persons who may have benefitted from hospice care do not receive it. This study aimed to examine the characteristics of, and one-year survivorship among, residents who received hospice care versus those who did not in long-term care facilities (LTCFs) in Canada. Methods This retrospective cohort study used linked health administrative data from the Canadian Continuing Reporting System (CCRS) and the Discharge Abstract Database (DAD). All persons who resided in a LTCF and who had a Resident Assessment Instrument Minimum Data Set Version 2.0 (RAI-MDS 2.0) assessment in the CCRS database between Jan. 1st, 2015 and Dec 31st, 2015 were included in this study (N = 185,715). Death records were linked up to Dec 31th, 2016. Univariate, bivariate and multivariate analyses were performed. Results The reported hospice care rate in LTCFs is critically low (less than 3%), despite one in five residents dying within 3 months of the assessment. Residents who received hospice care and died within 1 year were found to have more severe and complex health conditions than other residents. Compared to those who did not receive hospice care but died within 1 year, residents who received hospice care and were alive 1 year following the assessment were younger (a mean age of 79.4 [+ 13.5] years vs. 86.5 [+ 9.2] years), more likely to live in an urban LTCF (93.2% vs. 82.6%), had a higher percentage of having a diagnosis of cancer (50.7% vs. 12.9%), had a lower percentage of having a diagnosis of dementia (30.2% vs. 54.5%), and exhibited more severe acute clinical conditions. Conclusions The actual use of hospice care among LTCF residents is very poor in Canada. Several factors emerged as potential barriers to hospice use in the LTCF population including ageism, rurality, and a diagnosis of dementia. Improved understanding of hospice use and one-year survivorship may help LTCFs administrators, hospice care providers, and policy makers to improve hospice accessibility in this target group.

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Antipsychotic drug use in Canadian long-term care facilities: prevalence, and patterns following resident relocation

International Psychogeriatrics ◽

10.1017/s1041610205001730 ◽

2005 ◽

Vol 17 (2) ◽

pp. 179-193 ◽

Cited By ~ 20

Author(s):

Brad Hagen ◽

Chris Armstrong Esther ◽

Roland Ikuta ◽

Robert J. Williams ◽

Carole-Lynne Le Navenec ◽

...

Keyword(s):

Atypical Antipsychotics ◽

Long Term Care ◽

Average Length ◽

Term Care ◽

Care Facilities ◽

One Year ◽

The One ◽

New Facility ◽

Dose Reductions

Background and aims: Data on antipsychotic use were collected in two Canadian long-term care (LTC) facilities. During the one-year study, residents in one facility were relocated to a new facility, allowing examination of the changes in antipsychotic use associated with relocation.Method: A comparative descriptive design was used. Pharmacy and chart data on antipsychotic use were gathered for three separate one-month periods during one year. Data were collected both in a facility experiencing relocation of all residents to a new facility, and in a facility not undergoing relocation. The three one-month data collection periods covered a one-month period before the relocation, immediately after the relocation, and six months after the relocation.Results: In the facility not experiencing relocation, an average of 31.3% of all residents were receiving antipsychotics. Residents in this facility received antipsychotics for an average length of 0.81 years, and 20.8% of all antipsychotic prescriptions reflected dose reductions within six months of the start of the prescription. Only 8.1% of prescriptions had accompanying documentation on the behavioral indication for the use of antipsychotics. A total of 73.4% of all antipsychotics were ‘atypical’ antipsychotics, and 13.5% of all antipsychotic prescriptions were written as ‘p.r.n.’ (as needed). While the use of antipsychotics remained relatively constant in the non-relocation facility (between 30.3% and 33.1% of all residents), the percentage of residents receiving antipsychotics in the facility experiencing a relocation climbed significantly; from 21.5% six months before the move, to 32.6% immediately after the move, to 36.9% six months after the move.Conclusion: These findings, when compared with the U.S. standards on antipsychotic use (OBRA), suggest the need for additional research on antipsychotic use in Canadian LTC facilities.

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Risk of Hospitalization and Death Associated With Pimavanserin Use in Older Adults With Parkinson Disease

Neurology ◽

10.1212/wnl.0000000000012601 ◽

2021 ◽

pp. 10.1212/WNL.0000000000012601

Author(s):

Y. Joseph Hwang ◽

G. Caleb Alexander ◽

Huijun An ◽

Thomas J Moore ◽

Hemalkumar B Mehta

Keyword(s):

Older Adults ◽

Parkinson’S Disease ◽

Parkinson's Disease ◽

Long Term Care ◽

Term Care ◽

Risk Of Death ◽

Increased Risk ◽

Care Facilities ◽

One Year

Objective:To determine the risk of hospitalization and death associated with pimavanserin use.Methods:We conducted a retrospective cohort study of adults 65 years and older with Parkinson’s disease between November 1, 2015 and December 31, 2018 using an administrative dataset on residents of Medicare-certified long-term care facilities and linked Medicare claims data. Propensity score-based inverse probability of treatment weighting (IPTW) was used to balance pimavanserin users and nonusers on 24 baseline characteristics. Fine-Gray competing risk and Cox proportional hazards regression models were used to estimate the risk of hospitalization and death up to one year, respectively.Results:The study cohort included 2,186 pimavanserin users and 18,212 nonusers. There was a higher risk of 30-day hospitalization with pimavanserin use vs. nonuse (IPTW adjusted hazard ratio [aHR] 1.24, 95% confidence intervals [CI] 1.06–1.43). There was no association of pimavanserin use with 90-day hospitalization (aHR 1.10, CI 0.99–1.24) nor with 30-day mortality (aHR 0.76, CI 0.56–1.03). Pimavanserin use vs. nonuse was associated with an increased 90-day mortality (aHR 1.20, CI 1.02–1.41) that persisted after 180 days (aHR 1.28, CI 1.13–1.45) and 1 year (aHR 1.56, CI 1.42–1.72).Conclusions:Pimavanserin use vs. nonuse in older adults was associated with an increased risk of hospitalization at one month of initiation and a higher risk of death for up to one year following initiation. These findings, in a large real-world cohort within long-term care facilities, may help to inform decisions regarding its risk-benefit balance among patients with Parkinson’s disease.Classification of Evidence:This study provides Class II evidence that in patients with Parkinson’s disease who are 65 or older and residing in Medicare-certified long-term care facilities, pimavanserin prescribing is associated with an increased risk of 30-day hospitalization and higher 90-, 180-, and, 365-day mortality.

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Impact of Triplicate Prescription Program on Psychotropic Prescribing Patterns in Long-Term Care Facilities

Annals of Pharmacotherapy ◽

10.1177/106002809202600417 ◽

1992 ◽

Vol 26 (4) ◽

pp. 539-546 ◽

Cited By ~ 18

Author(s):

Abraham G. Hartzema ◽

Miquel S. Porta ◽

Hugh H. Tilson ◽

Sergio G. Zullich ◽

Thaddeus H. Grasela ◽

...

Keyword(s):

New York ◽

Adverse Events ◽

Hospital Admission ◽

Psychotropic Drug ◽

Long Term Care ◽

Prescribing Patterns ◽

Term Care ◽

Care Facilities ◽

One Year

OBJECTIVE: To assess the impact of the effect of the New York state triplicate prescription program on psychotropic prescribing patterns in selected long-term care facilities over a one-year period. DESIGN: Retrospective study for changes in psychotropic drug use patterns before and after implementation of the triplicate prescription program. SETTING: Eight private and two public long-term care facilities in the western New York area. PATIENTS: All residents in the long-term care facilities with complete medical records for a one-year period were reviewed. OUTCOME MEASUREMENTS: Charts were reviewed for changes in psychotropic drug patterns and incidence in adverse events such as falls, hip fractures, hospital admission, signs or symptoms of benzodiazepine (BZD) withdrawal syndrome, or behavioral outburst. MAIN RESULTS: BZD use declined precipitously from 25 percent of psychotropic drug orders to 10 percent six months after implementation of the program. The decline in BZD use was accompanied by an increase in the number of orders for alternative psychotropic agents. Although 22 percent of the patients previously receiving BZDs were discontinued from these drugs, more than half of these patients were switched to alternative therapy, including tricyclic antidepressants and antipsychotic drugs. The majority of patients who discontinued BZDs did so without tapering of the dosage; however, few experienced minor withdrawal symptoms and no patient experienced seizures or required hospitalization following discontinuation. The risk of falls, hospital admission for any reason, or combined events was not significantly altered despite a reduction in BZD use. There was a trend, however, for a reduction in falls after implementation of the program. CONCLUSIONS: This study documents that psychotropic drug prescribing patterns were significantly affected by the triplicate prescription program. BZD use declined; however, use of alternative psychotropic drugs increased. Despite changes in psychotropic prescribing patterns, we found no significant risk of adverse events. Further study to evaluate the long-term effect of alternative psychotropic drugs is necessary.

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