Identification of deprescribing opportunities for patients with diabetes and dementia discharged to a nursing home using a mortality prognostic index
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The prevalence of diabetes mellitus in elderly nursing home residents ranges from 25% to 34%. Glycemic goals for this patient population differ from those for the general population. Polypharmacy is a common issue in nursing home residents and is associated with significant complications. Deprescribing is one method to minimize polypharmacy. Deprescribing opportunities are frequently identified using a list of inappropriate medications. Use of a mortality prognostic index to identify deprescribing opportunities has not been studied in any patient population.
This was a noninterventional, retrospective, single-center cohort study at a 320-bed academic medical center. A total of 147 patients aged ≥ 65 years with dementia and type 2 diabetes mellitus receiving antihyperglycemic therapy during hospital admission were included. Life expectancy was calculated using the Mitchell Index. Opportunities for deprescribing were identified using glycated hemoglobin (HbA1c) levels and Mitchell Index scores. Patients were subcategorized into three groups based on their HbA1c (< 7%, 7–8%, and > 8%), and differences in life expectancy and functional status were determined.
In total, 106 patients (72%) were eligible for antihyperglycemic therapy deprescribing. The median HbA1c was 6.9% in the entire patient population. All three groups of patients had a high Mitchell Index score of 13.6 for HbA1c < 7%, 14.2 for HbA1c 7–8%, and 13.7 for HbA1c > 8%. The Mitchell Index scores estimated a 6-month mortality rate of at least 28% in this cohort. No differences in functional status or comorbidities were observed between HbA1c groups.
The 30-day mortality rates were higher than the predicted mortality rate in this patient population, indicating significant opportunities for deprescribing. Use of a mortality prognostic index, such as the Mitchell Index, for elderly nursing home residents with dementia can be considered to guide deprescribing.
The authors acknowledge the following students for assistance with data collection on this project: Moriah Muscaro, MD candidate 2019; Areej Usmani, MD candidate 2020; and Madison Ratycz, MD candidate 2020.
Compliance with ethical standards
Conflict of interest
Ammar Kayyali and Sarah E. Petite have no have no conflicts of interest that are directly relevant to the content of this article.
No sources of funding were used to conduct this study or prepare this manuscript.
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