Prevalent Statin Use in Long-Stay Nursing Home Residents With Life-Limiting Illness

Deborah S. Mack, MPH; Jennifer Tjia, MD, MSCE; Anne L. Hume, PharmD; Kate L. Lapane, PhD, MS


J Am Geriatr Soc. 2020;68(4):708-716. 

In This Article


Sample Characteristics

Overall, 79% of all eligible long-stay nursing home residents were identified as having a life-limiting illness (Figure 1). Of the final sample of 424 212 long-stay nursing home residents with life-limiting illness, 99.1% were diagnosed with one or more "serious illnesses" as defined by Kelley et al,[35] 16.1% had a condition that met the criteria in the PCI,[17,26] 3.1% had a documented prognosis less than 6 months, and less than 1% had evidence of a recent palliative consult (Figure 1; Table 1).[28]

Detailed sample characteristics are shown in Table 1. The sample was mostly non-Hispanic white women who had been in a nursing home for at least 1 year. Clinically, the sample was relatively impaired: almost half with moderate-severe cognitive impairment and most with moderate to extensive limitations in ADLs. In terms of diagnoses, most were consistent across age groups, with the exception of dementia. This included ASCVD conditions and risk factors. Polypharmacy was prevalent, with more than half concurrently prescribed more than five non-statin medications (as needed [PRN] and standing orders) and up to 20% on 11 or more medications.

Overall Statin use

The prevalence of statin use among the nursing home population with life-limiting illness was 34.0% (65-75 y = 44.0%; >75 y = 31.1%; Table 2). High-intensity statin use ranged from 5.4% to 11.1% with less use in the more advanced age. Specific generic brand statin use was consistent across age, with atorvastatin (16%-25%) the most commonly prescribed, followed by simvastatin (9%-11%) and pravastatin (5%-6%). Supplementary materials (Table S2 and Figure S2) provide more detailed information on statin use by intensity level and generic type.

Statin use by Life-limiting Illness Definitions

Partitioning the composite life-limiting illness definition into its four components, rates of statin use appeared to differ by the clinical basis of component definitions (diagnosis- vs prognosis-based criteria). For the diagnosis-based samples (serious illness or percutaneous coronary intervention conditions), statin use remained relatively consistent to overall rates by age. For the prognosis-based samples (<6 mo documented prognosis or palliative care consult), statin use ranged from 9% to 23%. Figure 2 shows a breakdown of statin use by age and life-limiting illness definition.

Figure 2.

Breakdown of statin use by life-limiting illness classification among long-stay nursing home residents (N = 424 212).

Factors Associated With Statin use

Table 2 shows all associations of resident factors with statin use, stratified by age.

Cohort 65 to 75 Years of Age. Some positive associations with statin use included non-Hispanic black race, use of five or more concurrent non-statin medications, ASCVD diagnosis, and ASCVD risk factors. In terms of residents less likely to be on statins, negative associations included severe cognitive and functional impairment, liver disease/cirrhosis, and evidence of a limited prognosis (eg, receipt of palliative care consult).

Cohort Older Than 75 Years. Some positive associations with statin use included minority race or ethnicity, use of five or more non-statin concurrent medications, an ASCVD diagnosis, and ASCVD risk factors. Negative associations included women gender, nursing home length of stay of 1 year or longer, severe cognitive and functional impairment, several serious illness diagnoses (eg, cancer, COPD/lung disease, liver disease/cirrhosis), and evidence of a limited prognosis.