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. 2022 Jan 3;17(1):11.
doi: 10.1007/s11657-021-01050-0.

Improving shared decision-making for osteoporosis pharmacologic therapy in nursing homes: a qualitative analysis

Cathleen S Colón-Emeric  1   2 , Emily J Hecker  3 , Eleanor McConnell  3   4 , Laurie Herndon  5 , Milta Little  3 , Tingzhong Xue  3 , Sarah Berry  5
Affiliations

Improving shared decision-making for osteoporosis pharmacologic therapy in nursing homes: a qualitative analysis

Cathleen S Colón-Emeric et al. Arch Osteoporos. .

Abstract

Decisions on whether to use pharmacologic osteoporosis therapy in skilled nursing facility residents are complex and require shared decision-making. Residents, proxies, and staff desire individualized fracture risk estimates that consider advanced age, dementia, and mobility. They want options for reducing administration burden, monitoring instructions, and periodic reassessment of risk vs. benefit.

Purpose: Decisions about pharmacologic osteoporosis treatment in nursing home (NH) residents with advanced age and multimorbidity are complex and should occur using shared decision-making. Our objective was to identify processes and tools to improve shared decision-making about pharmacologic osteoporosis treatment in NHs.

Methods: Qualitative analysis of data collected in three NHs from residents at high fracture risk, their proxies, nursing assistants, nurses, and one nurse practitioner (n = 28). Interviews explored participants' stories, attitudes, and experiences with oral osteoporosis medication management. Framework analysis was used to identify barriers to shared decision-making regarding osteoporosis treatment in this setting.

Results: Participants wanted individualized fracture risk estimates that consider immobility, advanced age, and comorbid dementia. Residents and proxies expected nursing staff to be involved in the decision-making; nursing staff wished to be informed on the relative risks vs. benefits of medications and given monitoring instructions. Two important competing demands to address during the shared decision-making process were burdensome administration requirements and polypharmacy. Participants wanted to reassess pharmacologic treatment appropriateness over time as clinical status or goals of care change.

Conclusions: Shared decision-making using strategies and tools identified in this analysis may move osteoporosis pharmacologic treatment in NHs and for other older adults with multimorbidity from inappropriate inertia to appropriate prescribing or appropriate inaction.

Keywords: Medical decision-making; Osteoporosis; Pharmacotherapy; Skilled nursing facilities.

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Figures

Figure 1.
Figure 1.
Shared Decision Making Framework for osteoporosis treatment decisions in NH Residents. Modified from Lebeau et al.[25]
See this image and copyright information in PMC

References

    1. Rapp K, et al., Hip Fractures in Institutionalized Elderly People: Incidence Rates and Excess Mortality. Journal of Bone and Mineral Research, 2008. 23(11): p. 1825–1831. - PubMed
    1. Rapp K, et al., Fractures after nursing home admission: incidence and potential consequences. Osteoporosis International, 2009. 20(10): p. 1775–1783. - PubMed
    1. Colón-Emeric C, et al., Prevalence and predictors of osteoporosis treatment in nursing home residents with known osteoporosis or recent fracture. Osteoporosis International, 2007. 18(4): p. 553–559. - PMC - PubMed
    1. Lyles KW, et al., Zoledronic Acid and Clinical Fractures and Mortality after Hip Fracture. New England Journal of Medicine, 2007. 357(18): p. 1799–1809. - PMC - PubMed
    1. Niznik JD, et al., Are Nursing Home Residents With Dementia Appropriately Treated for Fracture Prevention? Journal of the American Medical Directors Association, 2021. 22(1): p. 28–35.e3. - PMC - PubMed

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