Drug treatment at the end of life: An epidemiologic study in nursing homes

OBJECTIVE To examine drug treatment in nursing home patients at the end of life, and identify predictors of palliative drug therapy. DESIGN A historical cohort study. SETTING Three urban nursing homes in Norway. SUBJECTS All patients admitted from January 2008 and deceased before February 2013. MAIN OUTCOME MEASURES Drug prescriptions, diagnoses, and demographic data were collected from electronic patient records. Palliative end-of-life drug treatment was defined on the basis of indication, drug, and formulation. RESULTS 524 patients were included, median (range) age at death 86 (19-104) years, 59% women. On the day of death, 99.4% of the study population had active prescriptions; 74.2% had palliative drugs either alone (26.9%) or concomitantly with curative/preventive drugs (47.3%). Palliative drugs were associated with nursing home, length of stay > 16 months (AOR 2.10, 95% CI 1.12-3.94), age (1.03, 1.005-1.05), and a diagnosis of cancer (2.12, 1.19-3.76). Most initiations of palliative drugs and withdrawals of curative/preventive drugs took place on the day of death. CONCLUSION Palliative drug therapy and drug therapy changes are common for nursing home patients on the last day of life. Improvements in end-of-life care in nursing homes imply addressing prognostication and earlier response to palliative needs.