Population-based study examining the utilization of preventive medicines by older people in the last year of life

Sujita W. Narayan, Prasad S. Nishtala

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Aim: To examine the patterns of preventive medicines (PM) use in the last year of life of older adults. Methods: This study cohort included individuals (n = 99 809) aged ≥75 years who were in their last year of life. PM examined in this study included low-dose aspirin (≤325 mg/day), clopidogrel, dipyridamole, warfarin, dabigatran, statins and bisphosphonates. Logistic regression models examined the influence of age, sex, multimorbidity, socioeconomic status, and a diagnosis of cancer on the number and type of PM prescribed from 2007 to 2012. Results: The number of PM prescribed was higher for men compared with women (OR 1.11, 95% CI 1.08–1.14). Increasing age did not have an effect on the number of PM prescribed. The use of clopidogrel increased almost threefold from 2007 to 2012 (OR 5.53, 95% CI 4.61–6.65). In contrast, bisphosphonates use decreased significantly during the same period (OR 0.35, 95% CI 0.32–0.39). Individuals with a diagnosis of cancer had increased odds of PM utilization for antiplatelets, aspirin monotherapy and statins, which had remarkably high odds (OR 4.11, 95% CI 3.88–4.34, P < 0.001). Conclusions: The present explorative study highlighted that some PM, such as statins, continue to be prescribed until death, particularly those that might have been beneficial earlier in life, but have an uncertain or unfavorable risk–benefit ratio towards the end-of-life. Geriatr Gerontol Int 2018; 18: 892–898.

Original languageEnglish
Pages (from-to)892-898
Number of pages7
JournalGeriatrics and Gerontology International
Volume18
Issue number6
Early online date2 Feb 2018
DOIs
Publication statusPublished - 1 Jun 2018

Fingerprint

Preventive Medicine
utilization
medicine
clopidogrel
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Population
Diphosphonates
Aspirin
cancer
Logistic Models
Dipyridamole
Warfarin
Social Class
Comorbidity
social status
Neoplasms
Cohort Studies
logistics
Odds Ratio
death

Keywords

  • cancer
  • drug utilization
  • limited life expectancy
  • older people
  • preventive medicines

ASJC Scopus subject areas

  • Health(social science)
  • Gerontology
  • Geriatrics and Gerontology

Cite this

Population-based study examining the utilization of preventive medicines by older people in the last year of life. / Narayan, Sujita W.; Nishtala, Prasad S.

In: Geriatrics and Gerontology International, Vol. 18, No. 6, 01.06.2018, p. 892-898.

Research output: Contribution to journalArticle

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abstract = "Aim: To examine the patterns of preventive medicines (PM) use in the last year of life of older adults. Methods: This study cohort included individuals (n = 99 809) aged ≥75 years who were in their last year of life. PM examined in this study included low-dose aspirin (≤325 mg/day), clopidogrel, dipyridamole, warfarin, dabigatran, statins and bisphosphonates. Logistic regression models examined the influence of age, sex, multimorbidity, socioeconomic status, and a diagnosis of cancer on the number and type of PM prescribed from 2007 to 2012. Results: The number of PM prescribed was higher for men compared with women (OR 1.11, 95{\%} CI 1.08–1.14). Increasing age did not have an effect on the number of PM prescribed. The use of clopidogrel increased almost threefold from 2007 to 2012 (OR 5.53, 95{\%} CI 4.61–6.65). In contrast, bisphosphonates use decreased significantly during the same period (OR 0.35, 95{\%} CI 0.32–0.39). Individuals with a diagnosis of cancer had increased odds of PM utilization for antiplatelets, aspirin monotherapy and statins, which had remarkably high odds (OR 4.11, 95{\%} CI 3.88–4.34, P < 0.001). Conclusions: The present explorative study highlighted that some PM, such as statins, continue to be prescribed until death, particularly those that might have been beneficial earlier in life, but have an uncertain or unfavorable risk–benefit ratio towards the end-of-life. Geriatr Gerontol Int 2018; 18: 892–898.",
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AB - Aim: To examine the patterns of preventive medicines (PM) use in the last year of life of older adults. Methods: This study cohort included individuals (n = 99 809) aged ≥75 years who were in their last year of life. PM examined in this study included low-dose aspirin (≤325 mg/day), clopidogrel, dipyridamole, warfarin, dabigatran, statins and bisphosphonates. Logistic regression models examined the influence of age, sex, multimorbidity, socioeconomic status, and a diagnosis of cancer on the number and type of PM prescribed from 2007 to 2012. Results: The number of PM prescribed was higher for men compared with women (OR 1.11, 95% CI 1.08–1.14). Increasing age did not have an effect on the number of PM prescribed. The use of clopidogrel increased almost threefold from 2007 to 2012 (OR 5.53, 95% CI 4.61–6.65). In contrast, bisphosphonates use decreased significantly during the same period (OR 0.35, 95% CI 0.32–0.39). Individuals with a diagnosis of cancer had increased odds of PM utilization for antiplatelets, aspirin monotherapy and statins, which had remarkably high odds (OR 4.11, 95% CI 3.88–4.34, P < 0.001). Conclusions: The present explorative study highlighted that some PM, such as statins, continue to be prescribed until death, particularly those that might have been beneficial earlier in life, but have an uncertain or unfavorable risk–benefit ratio towards the end-of-life. Geriatr Gerontol Int 2018; 18: 892–898.

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