Changes in Prescribing Symptomatic and Preventive Medications in the Last Year of Life in Older Nursing Home Residents

Abstract

Background: At the end of life goals of care change from disease prevention to symptomatic control, however, little is known about the patterns of medication prescribing at this stage.Objectives: To explore changes in prescribing of symptomatic and preventive medication in the last year of life in older nursing home residents.Methods: A retrospective cohort study was conducted using pharmacy medication supply data of 553 residents from 16 nursing home facilities around Sydney, Australia. Residents received 24-h nursing care, were aged ≥ 65 years, died between June 2008 and June 2010 and were using at least one medication 1 year before death. Medications were classified as symptomatic, preventive, or other. A linear mixed model was used to compare changes in prescribing in the last year of life.Results: 68.1% of residents were female, mean age was 88.0 (SD: 7.5) years and residents used a mean of 9.1 (SD: 4.1) medications 1 year before death. The mean number of symptomatic medications per resident increased from 4.6 medications 1 year before death to 5.1 medications at death [95% CI 4.4–4.7 to 5.9–5.2, P = 0.000], while preventive medication decreased from 2.0 to 1.4 medications [95% CI 1.9–2.1 to 1.3–1.5, P = 0.000]. Symptomatic medications were used longer in the last year of life, compared to preventive medications (336.3 days [95% CI 331.8–340.8] versus 310.9 days [95% CI 305.2–316.7], P = 0.000).Conclusion: Use of medications for symptom relief increased throughout the last year of life, while medications for prevention of long-term complications decreased. But changes were slight and clinical relevance can be questioned.

Orodispersible films as a personalized dosage form for nursing home residents, an exploratory study

“…acetaminophen, fentanyl, or oxycodone) were often prescribed. This is in line with other studies examining drug utilization in nursing home residents [2,21,22]. Of the 341 different medications used, 34 were identified as suitable candidates for ODF formulation development in a (hospital) pharmacy environment.…”

“…Although, medication use of nursing home residents has been studied widely [21,22], there has been little attention to use such data as a basis to select candidates for age-appropriate and personalized geriatric medicinal products. In this study, the medication use of nursing home residents was examined to identify medications that are suitable for ODF formulation development, taking into account information on drug utilization and manufacturing-related characteristics of the drugs.…”

Medication use in aged care residents in the last year of life: A scoping review

“…Some studies found medication numbers increased before death, 33,53 while others found they decreased. 32,57,58 Sourdet et al 55 found that recognition that residents were at the end of life resulted in lower medication numbers. Chen et al 33 found having heart disease was associated with increased medication numbers.…”

“…antihypertensives) medication use towards the end of life. 30,41,58 One study 30 found that 84% of residents had their medication altered in the last month of life, with more having symptom-oriented changes than diagnosis-oriented changes. Another study 41 found that on the day of death, 73% of residents were prescribed a preventive medication and 74% were prescribed a palliative symptom-orientated medication.…”

“…In this study, longer length of stay in the nursing home, a cancer diagnosis and older age were associated with increased drug prescriptions aimed at palliation. Another study 58 found the mean number of symptomatic medications used at death was five, while the mean number of preventive medications used at death was one. Both studies that assessed changes over time found an increase in the number of medications aimed at symptom management and a decrease in preventive medications as death approached.…”