OAs in LTC Are Discontinuing Aspirin at End of Life

According to study results posted online in the Journal of the American Geriatrics Society, roughly one-quarter of older adults are discontinuing aspirin during end of life. Researchers note that this discontinuation could be directly related to the unclear role of aspirin at end of life.  

“Continuation of aspirin for secondary prevention in persons with limited life expectancy (LLE) is controversial,” study authors explained. “We sought to determine the incidence and predictors of aspirin discontinuation in veterans with LLE and/or advanced dementia (LLE/AD) who were taking aspirin for secondary prevention at nursing home admission, stratified by whether their limited prognosis (LP) was explicitly documented at admission.”

Lead study author, Sydney Springer, PharmD, VA Pittsburgh Healthcare System, and colleagues, conducted a retrospective cohort study. They used both Veterans Affairs (VA) and Medicare clinical/administrative data and Minimum Data Set resident assessments, and they focused on all VA nursing homes (referred to as community living centers [CLCs]) in the United States. 

Participants included in the study were older CLC residents, ages 65 years or older, with LLE/AD, admitted for 7 days or longer in fiscal years 2009 to 2015. Participants also had a history of coronary artery disease and/or stroke/transient ischemic attack and used aspirin within the first week of CLC admission (n = 13,844). 

“The primary dependent variable was aspirin discontinuation within the first 90 days after CLC admission, defined as 14 consecutive days of no aspirin receipt,” Dr Springer and colleagues explained.  

According to the findings of the study, among residents with explicit documentation of LP, 27% 27% (95% confidence interval [CI] = 26%-28%) in the full sample, 34% (95% CI = 33%-36%) discontinued aspirin. Among residents with no such documents, 24% (95% CI = 23%-25%) discontinued aspirin.  

The study authors noted that residents with and without explicit LP documentation at admission showed different associations of independent variables with aspirin discontinuation.  

“Just over one-quarter of patients discontinued aspirin, possibly reflecting the unclear role of aspirin in end of life among prescribers,” Dr Springer and colleagues concluded.  

“Future research should compare outcomes of aspirin deprescribing in this population.” 

—Julie Gould

Reference:

Springer SP, Mor MK, Sileanu F, et al. Incidence and Predictors of Aspirin Discontinuation in Older Adult Veteran Nursing Home Residents at End of Life [published online ahead of print, 2020 Feb 13]. J Am Geriatr Soc. 2020;10.1111/jgs.16346. doi:10.1111/jgs.16346