Drug prescribing changes in the last year of life among homebound older adults: national retrospective cohort study

Abstract

ObjectivesThis study aimed to evaluate the prescription patterns of drugs during the last year of life in homebound older adults who received home medical care.MethodsWe used a nationwide claims database in Japan and selected older adults aged ≥75 years who received home medical care services from ≥12 months before their death. We evaluated medications prescribed 12 months before death (month 12), 3 months before death (month 3) and in the last month of life (month 1). We explored the factors associated with the decreased number of cardiovascular preventive drugs from month 12 to both month 3 and month 1.ResultsA total of 118 661 participants were included, and the majority were aged ≥90 years and women. The prevalence of cardiovascular preventive drugs decreased but remained common in month 1, which included antihypertensives (34.7%), antiplatelets (15.9%), oral anticoagulants (7.6%), antidiabetic drugs (7.3%) and lipid-lowering drugs (6.1%). The relative decrease from month 12 to month 1 was the largest for lipid-lowering drugs (44.8%) and the smallest for oral anticoagulants (13.6%). Among other drugs, laxatives (enema), antiemetics, oral corticosteroids, analgesics, expectorants, bronchodilators and antibiotics showed a large relative increase. Older age, duration of home medical care services for <1 year and diagnoses of cancer, dementia and Parkinson’s disease were associated with a greater likelihood of a decreased number of cardiovascular preventive drugs.ConclusionsThere is room for deprescribing to avoid inappropriate polypharmacy by balancing preventive and symptom management drugs in those receiving home medical care with a limited life expectancy.

Factors associated with the introduction of visiting‐pharmacist services in older adults in Japan: A nested case–control study

“…In this study, polypharmacy of ≥10 medications and a diagnosis of depression, diabetes mellitus, ischemic heart disease, and cancer were positively associated with the introduction of visiting‐pharmacist services. This may be due to the complexity of prescription medications, the requirement for medication adjustments and reductions, 21 or the need for ad hoc responses to urgent changes in symptoms and narcotic management 10 . Visiting pharmacists may be required to play different roles for patients with or without cancer, and the process of service introduction may differ among such patients.…”

“…19,20 We examined recorded diagnoses on medical claims using ICD-10 codes including asthma/chronic obstructive pulmonary disease (COPD; J43-J46), cancer (C00-C97), depression (F31-F33), diabetes mellitus (E10-E14), heart failure (I50), ischemic heart disease (I20-I25), Parkinson disease (G20), and stroke (I60-I64), according to previous studies. 5,21 The number of prescribed medications was counted as one for outpatient prescriptions for all formulations with the same generic name and route of administration.…”

Symptomatic and preventive medication use according to age and frailty in Australian and Japanese nursing homes

“…The higher prevalence of antiplatelets, statins, and loop diuretics in Australia compared to Japan likely reflects the higher prevalence of coronary heart disease in the cohort (Australia 28.3%; Japan 11.7%). Japanese residents were more likely to be prescribed CCBs partly due to the lower risks of adverse events [30,31]. Japanese residents also had a considerably lower prevalence of vitamin D use (Japan 8.1%; Australia 52.0%), which may reflect initiatives in Australian NHs to increase vitamin D supplementation [32].…”