Statin Discontinuation in Nursing Home Residents with Advanced Dementia

ObjectivesTo describe patterns of, and factors associated with, statin use and discontinuation in nursing home (NH) residents progressing to advanced dementia and followed for at least 90days. DesignRetrospective inception cohort using a dataset linking 2007 to 2008 Minimum Data Set (MDS) to Medicare denominator and Part D files. SettingAll NHs in five states (Minnesota, Massachusetts, Pennsylvania, California, Florida). ParticipantsNH residents with dementia. MeasurementsResidents who developed advanced dementia were observed from baseline (date of progression to very severe cognitive impairment with eating problems) and followed for at least 90days to statin discontinuation or death. Logistic regression was used to identify baseline factors associated with statin use. Cox proportional hazard regression was used to identify factors associated with time to statin discontinuation. ResultsOf 10,212 residents, 16.6% (n=1,699) used statins. Greater odds of statin use were associated with having diabetes mellitus (adjusted odds ratio (AOR)=1.24, 95% confidence interval (CI)=1.09-1.40), stroke (AOR=1.31, 95% CI=1.16-1.48), and hypertension (AOR=1.35, 95% CI=1.18-1.54); hospice enrollment was associated with lower odds (AOR=0.75, 95% CI=0.64-0.89). In follow-up, 37.2% (n=632) discontinued statins. Median time to discontinuation was 36days (interquartile range 12-110days). Shorter time to discontinuation was associated with hospitalization in past 30days (adjusted hazard ratio (AHR)=1.67, 95% CI=1.40-1.99) and more daily medications (AHR=1.02, 95% CI=1.01-1.04). When statins were discontinued, 15.0% (n=95) of residents stopped only statins, and 47.5% (n=300) stopped at least one other medication. ConclusionMost NH residents who use statins at the time of progression to advanced dementia continue use in follow-up.