Medications That Older Adults in Hospice Care in the United States Take, 2007

Dwyer, Lisa L.; Lau, Denys T.

doi:10.1111/jgs.13795

Cited by 31 publications

(30 citation statements)

References 25 publications

(54 reference statements)

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“…It may be relevant that close to 70% of hospice patients were taking an opiate and an anxiolytic or hypnotic in the last week of life 118 . This is not evidence by itself whether this combination influences the survival of hospice patients, nor is the author commenting on the ethics of combining such drugs in a genuine hospice situation.…”

Section: Contributory Factors Combined With Hypnotics Could Cause Covmentioning

confidence: 99%

Hypnotic drug risks of mortality, infection, depression, and cancer: but lack of benefit

Kripke

2016

F1000Res

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This is a review of hypnotic drug risks and benefits, reassessing and updating advice presented to the Commissioner of the Food and Drug Administration (United States FDA). Almost every month, new information appears about the risks of hypnotics (sleeping pills). This review includes new information on the growing USA overdose epidemic, eight new epidemiologic studies of hypnotics’ mortality not available for previous compilations, and new emphasis on risks of short-term hypnotic prescription. The most important risks of hypnotics include excess mortality, especially overdose deaths, quiet deaths at night, infections, cancer, depression and suicide, automobile crashes, falls, and other accidents, and hypnotic-withdrawal insomnia. The short-term use of one-two prescriptions is associated with greater risk per dose than long-term use. Hypnotics are usually prescribed without approved indication, most often with specific contraindications, but even when indicated, there is little or no benefit. The recommended doses objectively increase sleep little if at all, daytime performance is often made worse, not better, and the lack of general health benefits is commonly misrepresented in advertising. Treatments such as the cognitive behavioral treatment of insomnia and bright light treatment of circadian rhythm disorders might offer safer and more effective alternative approaches to insomnia.

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Section: Contributory Factors Combined With Hypnotics Could Cause Covmentioning

confidence: 99%

Hypnotic drug risks of mortality, infection, depression, and cancer: but lack of benefit

Kripke

2016

F1000Res

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“…Prescribing medications may be particularly challenging during the transition from acute care hospital settings to hospice care because of the often abrupt shift in goals of care and changes in underlying indications for medication use. This is significant because nearly 40% of hospice patients are referred to hospice care from an acute care hospital, and previous large studies suggested that hospice patients receive an average of 10 to 16 medications including several medications with unclear indications in the hospice setting (eg, statins, antithrombotic therapy, and antibiotics) …”

mentioning

confidence: 99%

Frequency and Documentation of Medication Decisions on Discharge from the Hospital to Hospice Care

Kadoyama

Noble

Izumi

et al. 2019

J American Geriatrics Society

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OBJECTIVES To quantify the frequency and type of medication decisions on discharge from the hospital to hospice care. DESIGN Retrospective cohort study. SETTING A 544‐bed academic tertiary care hospital in Portland, Oregon. PARTICIPANTS A total of 348 adult patients (age ≥18 y) discharged to hospice care between January 1, 2010, and December 31, 2016. MEASUREMENTS Data were collected from an electronic repository of medical record data and a manual review of patients’ discharge summaries. Our outcomes of interest were the frequency and type of medication decisions documented in patients’ discharge summaries. Medication decisions were categorized as continuation, continuation but with changes in dose, route of administration, and/or frequency, discontinuation, and initiation of new medications. We also collected data on the frequency of patient/family in the participation of medication‐related decisions. RESULTS Patients were prescribed a mean of 7.1 medications (standard deviation [SD] = 4.8) on discharge to hospice care. The most prevalent medications prescribed on discharge were strong opioids (82.5%), anxiolytics/sedatives (62.9%), laxatives (57.5%), antiemetics (54.3%), and nonopioid analgesics (45.4%). However, only 67.8% (213/341) of patients who were prescribed an opioid on discharge to hospice care were also prescribed a laxative. Discharging providers made a mean of 15.0 decisions (SD = 7.2) per patient of which 28.5% were to continue medications without changes, 6.7% were to continue medications with changes, 30.3% were to initiate new medications, and 34.5% were to discontinue existing medications. Patients and/or family members were involved in medication decisions during 21.6% of discharges; patients were involved in 15.2% of decisions. CONCLUSION Patients averaged more than 15 medication decisions on discharge to hospice care. However, it was rarely documented that patients and/or their families participated in these decisions. J Am Geriatr Soc, 2019.

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“…A total of 12 studies were found to meet the inclusion criteria and were included in the review. (Table 1) Studies were conducted in nine different countries, with one study analysing data from 11 different European countries -Austria (n = 1) [17], Brazil (n = 1)(18), Canada (n = 1) [19], Germany (n = 1) (17), Italy (n = 2) [20,21], Netherlands (n = 2) [4,22], Norway (n = 1) [23], Switzerland (n = 1) [17] and USA (n = 3) [3,24,25]. The multinational study reported on medication use in Norway, Italy, Germany, the UK, Iceland, Sweden, Switzerland, Lithuania, Denmark, Finland and Greece [26].…”

Section: Resultsmentioning

confidence: 99%

“…It is apparent that there is a significant lack of published literature outlining drug usage in palliative care settings. However, three quarters (9/12) of the articles reviewed were published in the last 9 years (date range: 2011-2016) [3,4,18,[21][22][23][24][25][26]. The majority of studies used a retrospective means of data extraction [3,4,[19][20][21][23][24][25][26] and ranged in duration from 3 months to 5 years.…”

Section: Resultsmentioning

confidence: 99%

An overview of the use of drugs in palliative care settings worldwide

2019

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Introduction: To provide an overview of drug use in palliative care worldwide and to identify the most commonly used medicines in palliative care settings. Methods: Quasi-systematic review. Search strategy: Medline/PubMed, Embase, SCOPUS and Google Scholar were searched utilizing the selected MeSH terms: palliative care, hospice, drug utilization, and prescription patterns. Results: Overall, it is apparent that there is a significant lack of published literature outlining drug usage in palliative care settings. Twelve sources of information were reviewed from 9 different countries

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Medications That Older Adults in Hospice Care in the United States Take, 2007

Abstract: People continue to receive disease-focused therapies at the end of life rather than therapies exclusively for palliation of symptoms, suggesting that treatments may vary according to the person's primary diagnosis.

Cited by 31 publications

References 25 publications

Hypnotic drug risks of mortality, infection, depression, and cancer: but lack of benefit

Hypnotic drug risks of mortality, infection, depression, and cancer: but lack of benefit

Frequency and Documentation of Medication Decisions on Discharge from the Hospital to Hospice Care

An overview of the use of drugs in palliative care settings worldwide

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