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Health Care for the Elderly

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Elderly patients often discontinue use of cholesterol-lowering drugs that help to prevent heart problems and stroke

Lipid-lowering statin drugs substantially reduce the incidence of coronary heart disease-related problems and death as well as strokes in both elderly and non-elderly patients who remain on the medications for an average of 5 years. Unfortunately, many elderly patients stop taking statin drugs within the first 6 months of therapy.

Interventions that encourage maintenance of statin treatment (for example, patient education, counseling, reminders, and reinforcement) should be instituted early in treatment and among patients who are more likely to quit therapy, according to the first study to observe statin use in routine care settings. The study was supported in part by the Agency for Healthcare Research and Quality (National Research Service Award training grant T32 HS00020).

Led by Milton C. Weinstein, Ph.D., of the Harvard School of Public Health, the researchers studied statin use among 34,501 elderly patients enrolled in the New Jersey Medicaid and Pharmaceutical Assistance to the Aged and Disabled programs who began statin treatment between 1990 and 1998. They followed these patients until death, disenrollment, or December 31, 1999. They examined the proportion of days covered (PDC) by a statin in each quarter during the first year of therapy and every 6 months thereafter.

About 75 percent of patients did not maintain a PDC of at least 80 percent after 5 years, which is much higher than the 6 to 30 percent 5-year discontinuation rates reported in clinical trials. The proportion of patients with a PDC less than 80 percent increased in a linear fashion, accounting for 40, 61, and 68 percent of the group after 3, 12, and 120 months, respectively. Among elderly patients, those less likely to continue long-term therapy were black, older than 75 years, had lower income, had fewer cardiovascular problems when they began therapy, suffered from depression or dementia, or suffered from coronary heart disease problems such as a heart attack after starting treatment (perhaps because they perceived the drug to be ineffective).

More details are in "Long-term persistence in use of statin therapy in elderly patients," by Joshua S. Benner, Pharm.D., Sc.D., Robert J. Glynn, Ph.D., Sc.D., Helen Mogun, M.S., and others, in the July 24, 2002 Journal of the American Medical Association 288(4), pp. 455-461.

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