Abstract
Abstract
Nursing home (NH) residents use many medications. Medications are beneficial and nvery important for the wellbeing of nursing home residents, to treat symptoms and diseases, and avoid premature death. On the other hand, at the end of life, it is expected that for some medications, the potential benefits of use do not outweigh the disadvantages (e.g., side effects, costs, interactions, the daily burden of intake. These medications with questionable benefits are suitable for deprescribing. Deprescribing means stopping or tapering a medication.
Up to now, there is no high level evidence on the effects of changes in medication use (e.g. deprescribing medications with questionable benefits and initiating beneficial medications) at the end of life. In this project, we aim to evaluate these effects on morbidity, mortality and the quality of life of NH residents with limited life expectancy. We use innovative analytical techniques and big data (population data). BelRAI data contain information about quality of life, physical and psychosocial health (BelRAI V1-3.0). These data were linked to health claims databases (Inter-Mutualistic Agency), which include reimbursed treatment and medication data. Using the linked data, we can approximate an RCT. We can compare people whose use of a specific medication has changed (exposure group) with people whose use of this medication has not changed (control group), and thus measure the effects of changes in medication use on quality of life, morbidity, and mortality, without them being at real risk of, for example, dying earlier by stopping a medication in a prospective randomized experiment.
The project address with 5 objectives:
Already addressed by FWO project:
1. Umbrella review to identify tools and guidelines available for assessing medication appropriateness and aiding in the deprescribing of potentially inappropriate medications, evaluate their development and validation methods, determine the medications included within these tools and guidelines, and assess the level of evidence supporting their appropriateness. (Br J Clin Pharmacol. 2024 Jan;90(1):12-106)
2. A qualitative study to explore barriers and enablers for healthcare professionals in deprescribing medications for nursing home residents with limited life expectancy (accepted for publication in Geriatric Nursing on January 23 2025)
3. An interrupted time series study to assesses deprescribing trends and the impact of publications of international deprescribing guideline on these trends among nursing home residents with limited life expectancy. (Manuscript submitted)
4. A prospective cohort study to describe the evolution of health and medication use of a cohort of NH residents during the last months of life (data-analysis will be finished and reporting will have started)
To be addressed by DOCPRO 1
4. A prospective cohort study to describe the evolution of health and medication use of a cohort of NH residents during the last months of life (Manuscript to be prepared and submitted)
5. A matched cohort study to measure the effects of changes in medication use (i.e., initiation versus omission of beneficial medications, deprescribing versus continued use, and initiation versus non-initiation of medications with questionable benefits) on quality of life, mortality, and morbidity at the end of life in a cohort of NH residents with limited life expectancy. (data-analysis, reporting and publication)
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