Abstract
Background: Medications have a pivotal role in the prevention and management of many conditions. The decision to use a medicine in older populations involves consideration of a number of elements in addition to the traditional risk/benefit elements. While it can be expected that the goal of medications at the end of life may changes from disease prevention to symptomatic control, little is known about the patterns of medication use at the end of life and if changes in medication reflect potential changes in clinical need.
Objectives: The aim of this work was to explore changes in the utilization of preventive and symptomatic medications at the end of life in a cohort of elderly nursing home residents.
Methods: A retrospective observational cohort study of nursing home residents (n =3876) from 26 residential aged care facilities in the Sydney metropolitan area was conducted using pharmacy medication supply data. Patients aged ≥65 years who died in the nursing home between June 2008 and June 2010 were
included in the analysis. Medications were classified as symptomatic, preventive or other. A linear mixed model was used to compare the use of symptomatic
and preventive medication in their last year of life.
Results: Of the 3876 nursing home residents present in the cohort, 554 (14.3%) died within the study period and were included in the analysis. There were distinct differences in utilization of symptomatic and preventive medicines in the last year of life. Symptomatic medication use increased from 4.65 medications per resident 1 year before death to 5.18 medications at death (95%CI 4.43–4.88 vs. 4.96–5.41, p=0.000), while preventive medication use decreased from 1.96
to 1.40 medications (95%CI 1.83–2.10 vs. 1.26–1.53, p=0.000). The duration of use of symptomatic medications was longer than that for preventive medicines
(283.0 days (95%CI 273.7–292.3) vs. 257.3 days (95%CI 246.8–267.8), p=0.000).
Conclusions: The results suggest that some consideration is given to changing clinical need at the end of life, yet changes were small. Current healthcare
structures in aged care may limit the ability to be responsive to changed clinical need at the end of life.
Objectives: The aim of this work was to explore changes in the utilization of preventive and symptomatic medications at the end of life in a cohort of elderly nursing home residents.
Methods: A retrospective observational cohort study of nursing home residents (n =3876) from 26 residential aged care facilities in the Sydney metropolitan area was conducted using pharmacy medication supply data. Patients aged ≥65 years who died in the nursing home between June 2008 and June 2010 were
included in the analysis. Medications were classified as symptomatic, preventive or other. A linear mixed model was used to compare the use of symptomatic
and preventive medication in their last year of life.
Results: Of the 3876 nursing home residents present in the cohort, 554 (14.3%) died within the study period and were included in the analysis. There were distinct differences in utilization of symptomatic and preventive medicines in the last year of life. Symptomatic medication use increased from 4.65 medications per resident 1 year before death to 5.18 medications at death (95%CI 4.43–4.88 vs. 4.96–5.41, p=0.000), while preventive medication use decreased from 1.96
to 1.40 medications (95%CI 1.83–2.10 vs. 1.26–1.53, p=0.000). The duration of use of symptomatic medications was longer than that for preventive medicines
(283.0 days (95%CI 273.7–292.3) vs. 257.3 days (95%CI 246.8–267.8), p=0.000).
Conclusions: The results suggest that some consideration is given to changing clinical need at the end of life, yet changes were small. Current healthcare
structures in aged care may limit the ability to be responsive to changed clinical need at the end of life.
| Original language | English |
|---|---|
| Article number | 60 |
| Pages (from-to) | 35-36 |
| Number of pages | 2 |
| Journal | Pharmacoepidemiology and Drug Safety |
| Volume | 24 |
| Issue number | S1 |
| Publication status | Published - Sept 2015 |