Abstract
The prevention and treatment of chronic conditions are mainly based on pharmacologic therapy; therefore having multiple chronic conditions means the use of a number of medications in individuals aged ≥65 years. Among these, preventive medicines (PMs) such as antithrombotics, cholesterol lowering and bone preserving medicines are the most commonly prescribed.
Our explorative study aimed to examine the prescribing patterns of preventive medicines in older individuals in their last year of life. This retrospective cohort study included individuals (N=99,809) aged ≥75 years who were in their last year of life. PMs examined in this study included low-dose aspirin (≤325mg/day), clopidogrel, dipyridamole, warfarin, dabigatran, statins and bisphosphonates. Multinomial and logistic regression models were used to examine the influence of age, sex, multimorbidity, socioeconomic status and presence of a life-limiting illness (cancer) on the number and type of PMs prescribed (between 2007–2012).
The number of PMs prescribed to older individuals in their last year of life was higher for males compared to females (Relative Risk Ratio 1.34, 95% CI: 1.26–1.41). The number of PMs prescribed decreased as age increased. However, the use of clopidogrel increased over three-fold from 2007–2012 (Odds Ratio (OR) 7.55, 95% CI: 6.28–9.09). In contrast, bisphosphonates use decreased significantly during the same period (OR 0.44, 95% CI: 0.40–0.49). Individuals with a diagnosis of cancer had decreased odds of PMs utilisation except for antiplatelets, aspirin monotherapy and statins, which had remarkably high odds (OR 4.07, CI: 3.84–4.31, P
Over the last decade, a significant emphasis is being placed on the optimal use of medicines and deprescribing unnecessary medicines in individuals with multimorbidity and those approaching end-of-life. Our findings suggest that there is some evidence that the use of preventive medicines in older individuals diagnosed with cancer has declined.
Our explorative study aimed to examine the prescribing patterns of preventive medicines in older individuals in their last year of life. This retrospective cohort study included individuals (N=99,809) aged ≥75 years who were in their last year of life. PMs examined in this study included low-dose aspirin (≤325mg/day), clopidogrel, dipyridamole, warfarin, dabigatran, statins and bisphosphonates. Multinomial and logistic regression models were used to examine the influence of age, sex, multimorbidity, socioeconomic status and presence of a life-limiting illness (cancer) on the number and type of PMs prescribed (between 2007–2012).
The number of PMs prescribed to older individuals in their last year of life was higher for males compared to females (Relative Risk Ratio 1.34, 95% CI: 1.26–1.41). The number of PMs prescribed decreased as age increased. However, the use of clopidogrel increased over three-fold from 2007–2012 (Odds Ratio (OR) 7.55, 95% CI: 6.28–9.09). In contrast, bisphosphonates use decreased significantly during the same period (OR 0.44, 95% CI: 0.40–0.49). Individuals with a diagnosis of cancer had decreased odds of PMs utilisation except for antiplatelets, aspirin monotherapy and statins, which had remarkably high odds (OR 4.07, CI: 3.84–4.31, P
Over the last decade, a significant emphasis is being placed on the optimal use of medicines and deprescribing unnecessary medicines in individuals with multimorbidity and those approaching end-of-life. Our findings suggest that there is some evidence that the use of preventive medicines in older individuals diagnosed with cancer has declined.
| Original language | English |
|---|---|
| Journal | The New Zealand Medical Journal |
| Volume | 130 |
| Issue number | 1467 |
| Publication status | Published - 15 Dec 2017 |
