Opioids, Pain Management, and Palliative Care in a Norwegian Nursing Home From 2013 to 2018

Abstract

In Norway, approximately 50% of older people die in nursing homes (NH). Holistic care and pharmacological management are key factors in quality at the end of life. The purpose of this longitudinal study was to describe the use of opioids in an NH during a 5-year period. We focused on palliative care, symptoms, and suffering during the last 3 days before death. Data were collected from spring 2013 to spring 2018. We used the interRAI assessment instrument annually and when the resident died. We conducted a semi-structured interview with nurses on duty at the deathbed. At the time of death, the residents had an average age of 88.9 years and an average stay of 2.9 years (N = 100). At the first assessment, 19% of the residents used 1 or more type of opioids. On the day of death, 55% had an active prescription for opioids, mainly as subcutaneous injections. The results illustrate the different uses of opioids, including managing pain, dyspnoea, sedation, for comfort, as a prophylaxis, or a combination of reasons. Cancer-and cardiovascular diagnoses were the strongest predictor for using morphine (P < 0.05). Identification of the residents' needs for opioids is a challenge for palliative care nurses, both ethically and legally.

Cultural and Ethical Barriers to Cancer Treatment in Nursing Homes and Educational Strategies: A Scoping Review

“…This category includes 16 studies distributed in six subcategories: physical symptoms, impact of cognitive impairment, pain management, severity of pain, neuropsychiatric symptoms, and the role of the nurse in psychological symptoms [ 22 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 ].…”

“…A group of researchers in Norway found that the diagnosis of cancer led to an increase in the use of pain relievers over time, reflecting that cancer patients were in more pain than those without cancer. The main indication for using opioids close to death in nursing home residents, regardless of cancer diagnosis, was pain (22.0%), a combination of different reasons (22.0%), prophylaxis (18.0%), dyspnea (14.0%), sedation (11.0%), or for comfort (13.0%) [ 38 ]. When a patient received palliative care, pain management was enhanced with scheduled and as-needed medication [ 39 ].…”

Práticas de cuidado hospitalares no final de vida: revisão integrativa

“…Estudo norueguês (Sørbye et al, 2019) verificou que mais da metade dos pacientes em final de vida utilizaram opioides para dor ou dispneia. A morfina foi utilizada pela via subcutânea, corroborando com os achados anteriormente apresentados.…”

“…A morfina foi utilizada pela via subcutânea, corroborando com os achados anteriormente apresentados. Entretanto, o estudo (Sørbye et al, 2019) concluiu que raramente foi prescrita nutrição parenteral ou hidratação intravenosa no final da vida, o que vai de encontro ao evidenciado na presente revisão.…”

Reform influences location of death: Interrupted time-series analysis on older adults and persons with dementia

“…First, using death certificate data that does not provide detailed information regarding changes in places of care closest to death. Second, we relied on the death certificate to identify persons with dementia making these estimates a conservative underestimate [ 45 ]. We know that at least 80% of persons in Norwegian long-term NHs have cognitive impairment [ 46 ].…”