You are here

Article Text

Article menu
Download PDFPDF
Original research
Drug prescribing changes in the last year of life among homebound older adults: national retrospective cohort study
  1. Yukari Hattori1,
  2. Shota Hamada2,3,4,
  3. Takashi Yamanaka3,
  4. Kiwami Kidana3,
  5. Masao Iwagami4,
  6. Nobuo Sakata4,
  7. Nanako Tamiya4,
  8. Taro Kojima1,
  9. Sumito Ogawa1 and
  10. Masahiro Akishita1
  1. 1 Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
  2. 2 Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan
  3. 3 Department of Home Care Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
  4. 4 Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
  1. Correspondence to Dr Shota Hamada, Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo 105-0003, Japan; shota.hamada{at}ihep.jp

Abstract

Objectives This study aimed to evaluate the prescription patterns of drugs during the last year of life in homebound older adults who received home medical care.

Methods We 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.

Results A 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.

Conclusions There 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.

  • Home care
  • Drug administration

Data availability statement

No data are available. No data are available. The data extracted from the NDB cannot be used except by those who are authorised to do so.

https://doi.org/10.1136/spcare-2022-003639

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Data availability statement

    No data are available. No data are available. The data extracted from the NDB cannot be used except by those who are authorised to do so.

    View Full Text

    Footnotes

    • Contributors YH contributed to the study concept and design, analysis and interpretation of data and drafting of the manuscript. SH contributed to the study concept and design, acquisition of data, analysis and interpretation of data and critical revision of the manuscript for important intellectual content. SH is responsible for the content as guarantor. TY, KK, MI, NS and MA contributed to the study concept and design, interpretation of data and critical revision of the manuscript for important intellectual content. NT, TK and SO contributed to the interpretation of data and critical revision of the manuscript for important intellectual content.

    • Funding This work was supported by the JSPS KAKENHI (grant number 20K18868).

    • Disclaimer The funding body had no involvement in study design, data collection, analysis and interpretation of data, writing of the report or in the decision to submit the article for publication.

    • Competing interests SH, TY and KK belong to an endowed chair funded by donations from Mr Kazuteru Noguchi, JSH, Towa Pharmaceutical, Sawai Pharmaceutical and Ain Pharmaciez. NT received research funding from SMS and FAST DOCTOR. MA received remuneration from Astellas Pharma, Boehringer Ingelheim, Daiichi Sankyo, Eisai, Eli Lilly Japan, Mitsubishi-Tanabe Pharma, Mochida Pharmaceutical, MSD, Ono Pharmaceutical, Pfizer Japan, Sumitomo Dainippon Pharma and Takeda Pharmaceutical, and received research funding from Astellas Pharma, AstraZeneca, Bayer Health Care, Boehringer Ingelheim, Chugai Pharmaceutical, Daiichi Sankyo, Eli Lilly Japan, Kowa Pharmaceutical, Mitsubishi-Tanabe Pharma, Mochida Pharmaceutical, MSD, Ono Pharmaceutical, Otsuka Pharmaceutical, Pfizer Japan, Taisho Toyama Pharmaceutical, Takeda Pharmaceutical and Tsumura.

    • Provenance and peer review Not commissioned; externally peer reviewed.