Neglected by the evidence: Nursing Home Residents with Cardiovascular Disease

Background: By the year 2030, the silver tsunami will be in full force; 20% of the population will be 65 years of age or older, and 5% over 80 years of age. Aging-related changing pharmacokinetics and pharmacodynamics complicates drug therapy in older adults. Findings from randomized clinical trials continue to be limited in their generalizability because elderly persons are frequently excluded and the outcomes studied may not be the ones most relevant to very elderly adults. When older adults are included, the population is often highly selected. Herein lies the geriatric pharmacoparadox – the persons most likely to be using cardiovascular medications are the least likely to be included in trials. For residents in nursing homes (a little studied, but important segment of the health care sector serving 1.5 million people each year in the United States), little is known about the clinical complexity and care needs of those with cardiovascular disease.
Objective: To describe the clinical and functional characteristics of nursing home residents with cardiovascular disease
Methods: We used a comprehensive, national database including all nursing home residents in the United States (2011-2013). We identified residents with an active diagnosis of cardiovascular disease and described their comorbid conditions, physical functioning, and cognitive impairment.
Results: Cardiovascular disease was prevalent. Among those with cardiovascular diasese, physical and functional impairment increased with age, but the complexity of their drug regimens did not. The vast majority had two or more chronic conditions and had 3 or more medications regularly.
Conclusion: Nursing home residents with cardiovascular disease represent a frail, clinically complex population suffering from multiple comorbidities with complex medication regimens. The promise of using existing data sources coupled with advanced analytic methods to understand which medications, at which dose and in which patients disease-modifying treatments for cardiovascular disease is appropriate will be discussed.