Methodological Challenges for Epidemiologic Studies of Deprescribing at the End of Life

Purpose of Review: To describe approaches to measuring deprescribing and associated outcomes in studies of patients approaching end of life (EOL). Recent Findings: We reviewed studies published through 2020 that evaluated deprescribing in patients with limited life expectancy and approaching EOL. Deprescribing includes reducing the number of medications, decreasing medication dose(s), and eliminating potentially inappropriate medications. Tools such as STOPPFrail, OncPal, and the Unnecessary Drug Use Measure can facilitate deprescribing. Outcome measures vary and selection of measures should align with the operationalized deprescribing definition used by study investigators. Summary: EOL deprescribing considerations include medication appropriateness in the context of patient goals for care, expected benefit from medication given life expectancy, and heightened potential for medication-related harm as death nears. Additional data are needed on how EOL deprescribing impacts patient quality of life, caregiver burden, and out-of-pocket medication-related costs to patients and caregivers. Investigators should design deprescribing studies with this information in mind

Heart failure among US nursing home residents with diabetes mellitus

BACKGROUND: Type 2 diabetes mellitus is associated with an increased risk of developing heart failure. However, few recent studies have examined the characteristics of older adults living in US nursing homes with heart failure and diabetes mellitus. This study is important for clinical practice and public health action plans for heart failure. OBJECTIVE: To estimate the prevalence of, and factors associated with, heart failure in long-stay nursing home residents with diabetes mellitus. METHODS: We conducted a cross-sectional study using the US 2016 Minimum Data Set data consisting of all residents with diabetes aged \u3e /=65 years in Medicare/Medicaid certified nursing homes (n = 297,570). Diabetes mellitus and heart failure were operationalized using the resident\u27s transfer notes at admission and the progress notes during admission through physical examination findings and current treatment orders. RESULTS: Among all residents with diabetes, 26.4% had heart failure. Increasing age of residents, and comorbidities including coronary artery disease (aOR: 1.34; 95% CI: 1.31-1.37), end stage renal disease (aOR: 1.30; 95% CI: 1.26-1.35), and chronic obstructive pulmonary disease (aOR: 1.60; 95% CI: 1.57-1.63) were associated with a higher odds of heart failure. CONCLUSIONS: This is one of the first U.S studies to examine the prevalence and factors associated with heart failure in nursing home residents with diabetes mellitus. It highlights a clinically complex population with multiple comorbid conditions. Future research is needed to understand the pharmacological management of these residents and the extent to which appropriate management can improve quality of life for a medically vulnerable population