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Erschienen in: Archives of Osteoporosis 1/2022

01.12.2022 | Original Article

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

verfasst von: Cathleen S. Colón-Emeric, Emily J. Hecker, Eleanor McConnell, Laurie Herndon, Milta Little, Tingzhong Xue, Sarah Berry

Erschienen in: Archives of Osteoporosis | Ausgabe 1/2022

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Abstract

Summary

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.
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Metadaten
Titel
Improving shared decision-making for osteoporosis pharmacologic therapy in nursing homes: a qualitative analysis
verfasst von
Cathleen S. Colón-Emeric
Emily J. Hecker
Eleanor McConnell
Laurie Herndon
Milta Little
Tingzhong Xue
Sarah Berry
Publikationsdatum
01.12.2022
Verlag
Springer London
Erschienen in
Archives of Osteoporosis / Ausgabe 1/2022
Print ISSN: 1862-3522
Elektronische ISSN: 1862-3514
DOI
https://doi.org/10.1007/s11657-021-01050-0

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