Utilization of drugs for the management of cardiovascular diseases at intermediate care facilities for older adults in Japan

Shota Hamada; Taro Kojima; Hiroshi Maruoka; Shinya Ishii; Yukari Hattori; Jiro Okochi; Masahiro Akishita

doi:10.1016/j.archger.2020.104016

Utilization of drugs for the management of cardiovascular diseases at intermediate care facilities for older adults in Japan

Arch Gerontol Geriatr. 2020 May-Jun:88:104016. doi: 10.1016/j.archger.2020.104016. Epub 2020 Jan 25.

Authors

Shota Hamada¹, Taro Kojima², Hiroshi Maruoka³, Shinya Ishii², Yukari Hattori², Jiro Okochi⁴, Masahiro Akishita²

Affiliations

¹ Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan; Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan. Electronic address: shota.hamada@ihep.jp.
² Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
³ Yokohama Aobanosato Geriatric Health Services Facility, Yokohama, Japan.
⁴ Tatsumanosato Geriatric Health Services Facility, Daito, Japan.

PMID: 32045709
DOI: 10.1016/j.archger.2020.104016

Abstract

Objectives: No established approaches exist for the pharmacological management of cardiovascular diseases (CVDs) in residents of long-term care facilities (LTCFs). This study aimed to evaluate the use of drugs for CVD prevention and treatment (CVD-related drugs) in a major type of LTCF in Japan.

Methods: This study included 1318 randomly selected residents at 349 intermediate care facilities for older adults (called Roken). Prescriptions were investigated at admission and two months after admission according to therapeutic categories. Logistic regression was used to identify residents' characteristics that were associated with prescriptions of CVD-related drugs.

Results: Prescriptions of all types of drugs and CVD-related drugs decreased in 36 % and 16 % of residents, respectively. Half of the residents received antihypertensives, a quarter received antiplatelets and diuretics, whereas one-tenth received antidiabetics, oral anticoagulants, and lipid-modifying drugs. The prevalence of most of individual drug categories were similar among residents with different physical or cognitive function, except for fewer antihypertensive and lipid-modifying drugs in those with severe cognitive disability. Adjusted analyses for prescriptions at two months after admission revealed that bedridden residents were more likely to be prescribed diuretics but less likely to be prescribed antihypertensives, antiplatelets, or lipid-modifying drugs. Residents with severe cognitive disability were less likely to be prescribed antihypertensives or lipid-modifying drugs. A known history of cardiovascular events was associated with greater use of CVD-related drugs.

Conclusion: CVD-related drugs were commonly prescribed for Roken residents, including those with low physical and cognitive functions. Deprescribing may contribute to the optimization of pharmacotherapy in LTCF residents.

Keywords: Cardiovascular disease; Deprescribing; Intermediate care facility; Long-term care facility; Nursing home; Polypharmacy.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Antihypertensive Agents* / therapeutic use
Cardiovascular Diseases* / drug therapy
Cardiovascular Diseases* / epidemiology
Humans
Hypolipidemic Agents / therapeutic use
Intermediate Care Facilities*
Japan / epidemiology
Long-Term Care
Platelet Aggregation Inhibitors* / therapeutic use
Practice Patterns, Physicians'
Skilled Nursing Facilities

Substances

Antihypertensive Agents
Hypolipidemic Agents
Platelet Aggregation Inhibitors