Discontinuation of Preventive Medicines in Older People with Limited Life Expectancy: A Systematic Review

Narayan, Sujita W.; Nishtala, Prasad S.

doi:10.1007/s40266-017-0487-1

Cited by 37 publications

(32 citation statements)

References 31 publications

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“…To our knowledge, no previous study has been carried out to study gender differences in statin discontinuation in patients with advanced cancer disease. In studies on statin discontinuation in non-cancer patients, the majority of the participants have been men [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Differences in discontinuation of statin treatment in women and men with advanced cancer disease

et al. 2018

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BackgroundStatins are often discontinued in patients with advanced cancer since the net effect of treatment is considered negative. However, guidelines concerning discontinuation of statin treatment are lacking. The aim of this study was to investigate any differences in time of discontinuation of statin treatment between men and women with advanced cancer disease.MethodsMedical records from 195 deceased palliative cancer patients from a previous study cohort were reviewed. Patients treated with statins 2 years before death were identified as “statin users.” The time of discontinuation of statin therapy was identified and correlated to time of death. Only patients that had incurable cancer disease at time of statin discontinuation were included in the analysis.ResultsFifty-four patients were identified as statin users, 29 women and 25 men. The average time span between discontinuation of statin treatment and time of death was significantly longer in women than in men, 10 months compared to 4 months (p < 0.01), with a range of 1–24 months among women and 1–12 months for men. All patients died due to their cancer disease. More men than women had a history of stroke or cardiac infarction (p = 0.02). There were no differences in age, socioeconomic factors, or survival time from study inclusion between men and women. There was no difference in self-assessed quality of life (QoL) between statin users who had discontinued statin treatment and those who are still on treatment. Men generally assessed their QoL lower than women in this study (p = 0.03).ConclusionStatin treatment was discontinued earlier in women than in men in patients with advanced cancer. The data suggest that statins may be discontinued earlier in men as well, since earlier discontinuation did not affect cardiovascular mortality.

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Section: Discussionmentioning

confidence: 99%

Differences in discontinuation of statin treatment in women and men with advanced cancer disease

et al. 2018

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“…The older population with life‐limiting illness (LLI) and/or limited life expectancy (LLE) frequently face the burden of potentially inappropriate medication (PIM) and polypharmacy, which are known to be associated with poor health outcomes such as reduced quality of life (QOL), adverse drug reactions, falls, hospitalisation and mortality . It has been suggested that diagnosis of LLI or LLE should favour discontinuation of preventive medicines . However, evidence in the literature indicates that older patients continue to receive preventive medicines, or medicines that are not prescribed as symptomatic treatment, without consideration of the diagnosis of LLI .…”

Section: Introductionmentioning

confidence: 99%

“…Systematic reviews on deprescribing of PIMs or discontinuation of preventive medication in patients with LLI and reduced life expectancy have been conducted . The findings from these reviews illustrate that older patients with LLI and LLE continue to receive preventive medication.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of deprescribing interventions in older patients with life‐limiting illness and limited life expectancy: A systematic review

Shrestha

Poudel

Steadman

et al. 2019

Brit J Clinical Pharma

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Aims Older patients with life‐limiting illness (LLI) and limited life expectancy (LLE) continue to receive potentially inappropriate medicines, consequently deprescribing is often necessary. However, deprescribing in this population can be complex and challenging. Therefore, we aimed to investigate the evidence for outcomes of deprescribing interventions in older patients with LLI and LLE. Methods Studies on deprescribing intervention and their outcomes in age ≥65 years with LLI and LLE were searched using PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO and Google Scholar. Medication appropriateness was primary outcome, while clinical and cost‐related outcomes were secondary. Eligibility, data extraction and quality assessment were followed by a narrative synthesis of data. Results Of 9 studies (1375 participants), 3 reported on primary outcome. One study showed a significant reduction in medication inappropriateness by 34.9% (P < .001) from admission to close‐out, the second achieved 29.4% (P < .001) and 15.1% (P = .003) reduction at 12 and 24 months, respectively. The third reported that their intervention stopped (17.2%) and altered the dose (2.6%) of high‐risk medications. Commonly reported clinical outcomes were mortality (n = 3), quality of life (n = 2) and falls (n = 2). Outcomes in terms of cost were reported as overall cost (n = 2), medication cost (n = 1) and health care expenditure (n = 1). Conclusion Our findings suggest that deprescribing in older patients with LLI and LLE can improve medication appropriateness, and has potential for enhancement of several clinical outcomes and cost savings, but the evidence needs to be better established.

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“…These utilization trends aid in recognizing rational medicine use, access to medicines, and compare observed patterns with evidence and guideline‐based prescribing. Several studies have explored concomitant medicine use in the last year of life, particularly in individuals with limited life expectancy; however, there is limited literature on the patterns of PM use during this time . The present explorative study aimed to examine the prescribing patterns of PM in older individuals in their last year of life.…”

Section: Introductionmentioning

confidence: 99%

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

Narayan

Nishtala

2018

Geriatrics Gerontology Int

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Discontinuation of Preventive Medicines in Older People with Limited Life Expectancy: A Systematic Review

Cited by 37 publications

References 31 publications

Differences in discontinuation of statin treatment in women and men with advanced cancer disease

Differences in discontinuation of statin treatment in women and men with advanced cancer disease

Outcomes of deprescribing interventions in older patients with life‐limiting illness and limited life expectancy: A systematic review

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

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