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Drug Prescriptions in Nursing Home Residents during their Last 6 Months of Life: Data from the IQUARE Study

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The journal of nutrition, health & aging

Abstract

Objective

To assess the drug prescriptions of nursing home (NH) residents during the 6 months prior to their death, and the impact of the recognition of « life expectancy lower than 6 months » by the NH staff on the prescriptions.

Design

Prospective study.

Setting

175 nursing homes in France.

Participants

6275 residents were included from May to June 2011.

Measurements

The initial drug prescriptions of the residents who deceased within 6 months were compared with those who did not decease. Among the residents deceased within 6 months, the drug prescriptions were compared between the residents who were «considered at the end of their life» and those who were not. Potentially inappropriate prescriptions (PIP) were analyzed using Laroche criteria and a list of therapies considered as inappropriate at the end of life.

Results

498 residents (7.9%) died within 6 months after their inclusion: they had significantly more therapies (8.3 ± 3.8 vs. 7.9 ± 3.5, p=0.048) than non-deceased people. Sixty-one of the residents deceased within 6 months were considered by the NH staff as «end of life residents » (12.2%). They received significantly less drugs (6.4 ± 4.2 vs 8.5 ± 3.6, p<0.001) than NH’s residents not identified at the end of their life. They had a more frequent prescription of opioids (p<0.001), and less antipsychotics (p<0.001), lipid-lowering drugs (p=0.006), or antihypertensive therapies (p<0.01). They also received significantly less PIP (59.0% received at least one inappropriate prescription, vs. 87.2%, p<0.001).

Conclusion

An important proportion of nursing home residents received PIP. The quality of prescriptions in patients identified at the end of their life seems to improve, but more than half still receive inappropriate drugs. Special attention in prescribing should be given to these patients presenting a high risk of adverse events.

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References

  1. Christopher M. Benchmarks to improve end of life care. Kans City MO Midwest Bioeth Cent, 2000.

    Google Scholar 

  2. Blanpain N, Chardon O. Projections de population à l’horizon 2060: “Un tiers de la population âgé de plus de 60 ans.” Insee Prem. 2010;1320:1–4.

    Google Scholar 

  3. Wallace CL, Swagerty D, Barbagallo M, Vellas B, Cha HB, Holmerova I, et al. IAGG/IAGG GARN International Survey of End-of-Life Care in Nursing Homes. J Am Med Dir Assoc 2017;18:465–469. doi.org/10.1016/j.jamda.2017.04.002

    Article  PubMed  Google Scholar 

  4. Swagerty D. Integrating palliative care in the nursing home: an interprofessional opportunity. J Am Med Dir Assoc 2014;15:863–865. doi.org/10.1016/j. jamda.2014.09.008

    Article  PubMed  Google Scholar 

  5. Weathers E, O’Caoimh R, Cornally N, Fitzgerald C, Kearns T, Coffey A, et al. Advance care plan-ning: A systematic review of randomised controlled trials conducted with older adults. Maturitas. 2016;91:101–109. doi.org/10.1097/01. JAM.0000123063.79715.8E

    Article  PubMed  Google Scholar 

  6. Oliver DP, Porock D, Zweig S. End-of-life care in U.S. nursing homes: a review of the evidence. J Am Med Dir Assoc 2004;5:147–55.

    PubMed  Google Scholar 

  7. Perri M, Menon AM, Deshpande AD, Shinde SB, Jiang R, Cooper JW, et al. Adverse outcomes associated with inappropriate drug use in nursing homes. Ann Pharmacother 2005;39:405–411. doi.org/10.1345/aph.1E230

    Article  PubMed  Google Scholar 

  8. Ruggiero C, Dell’Aquila G, Gasperini B, Onder G, Lattanzio F, Volpato S, et al. Potentially inap-propriate drug prescriptions and risk of hospitalization among older, Italian, nursing home residents: the ULISSE project. Drugs Aging 2010;27:747–758. doi.org/10.2165/11538240-000000000-00000

    Article  PubMed  Google Scholar 

  9. Tamura BK, Bell CL, Inaba M, Masaki KH. Outcomes of polypharmacy in nursing home residents. Clin Geriatr Med 2012;28:217–236. doi.org/10.1016/j. cger.2012.01.005

    Article  PubMed  Google Scholar 

  10. Beers MH, Ouslander JG, Rollingher I, Reuben DB, Brooks J, Beck JC. Explicit criteria for deter-mining inappropriate medication use in nursing home residents. UCLA Division of Geriatric Medicine. Arch Intern Med 1991;151:1825–1832.

    Article  PubMed  CAS  Google Scholar 

  11. Laroche M-L, Charmes J-P, Merle L. Potentially inappropriate medications in the elderly: a French consensus panel list. Eur J Clin Pharmacol 2007;63:725–731. doi. org/10.1007/s00228-007-0324-2

    Article  PubMed  Google Scholar 

  12. O’Mahony D, O’Sullivan D, Byrne S, O’Connor MN, Ryan C, Gallagher P. STOPP/START crite-ria for potentially inappropriate prescribing in older people: version 2. Age Ageing 2015;44:213–218. doi.org/10.1093/ageing/afu145

    Article  PubMed  Google Scholar 

  13. Cruz-Jentoft AJ, Boland B, Rexach L. Drug therapy optimization at the end of life. Drugs Aging 2012;29:511–521. doi.org/10.2165/11631740-000000000-00000

    Article  PubMed  Google Scholar 

  14. Gordon M. Ethical challenges in end-of-life therapies in the elderly. Drugs Aging 2002;19:321–329.

    Article  PubMed  Google Scholar 

  15. O’Mahony D, O’Connor MN. Pharmacotherapy at the end-of-life. Age Ageing 2011;40:419–422. doi.org/10.1093/ageing/afr059

    Article  PubMed  Google Scholar 

  16. De Souto Barreto P, Lapeyre-Mestre M, Mathieu C, Piau C, Bouget C, Cayla F, et al. A multicen-tric individually-tailored controlled trial of education and professional support to nursing home staff: re-search protocol and baseline data of the IQUARE study. J Nutr Health Aging 2013;17:173–178. doi.org/10.1007/s12603-013-0008-9

    Article  PubMed  Google Scholar 

  17. Rolland Y, Mathieu C, Piau C, Cayla F, Bouget C, Vellas B, et al. Improving the Quality of Care of Long-Stay Nursing Home Residents in France. J Am Geriatr Soc 2016;64:193–199. doi.org/10.1111/jgs.13874

    Article  PubMed  Google Scholar 

  18. Agar M, Beattie E, Luckett T, Phillips J, Luscombe G, Goodall S, et al. Pragmatic cluster random-ised controlled trial of facilitated family case conferencing compared with usual care for improving end of life care and outcomes in nursing home residents with advanced dementia and their families: the IDEAL study protocol. BMC Palliat Care 2015;14:63. doi.org/10.1186/s12904-015-0061-8

    Article  PubMed  PubMed Central  Google Scholar 

  19. Husebo BS, Achterberg W, Flo E. Identifying and Managing Pain in People with Alzheimer’s Dis-ease and Other Types of Dementia: A Systematic Review. CNS Drugs 2016;30;481–497. doi.org/10.1007/s40263-016-0342-7

    Article  PubMed  PubMed Central  Google Scholar 

  20. Reinhardt JP, Boerner K, Downes D. The Positive Association of End-of-Life Treatment Discus-sions and Care Satisfaction in the Nursing Home. J Soc Work End—Life Palliat Care 2015;11:307–322. doi.org/10.1080/15524256.2015.1107805

    Article  PubMed  Google Scholar 

  21. Van Soest-Poortvliet MC, van der Steen JT, Gutschow G, Deliens L, Onwuteaka-Philipsen BD, de Vet HCW, et al. Advance Care Planning in Nursing Home Patients With Dementia: A Qualitative Inter-view Study Among Family and Professional Caregivers. J Am Med Dir Assoc 2015;16:979–989. doi.org/10.1016/j. jamda.2015.06.015

    Article  PubMed  Google Scholar 

  22. Bainbridge D, Seow H, Sussman J, Pond G. Factors associated with acute care use among nursing home residents dying of cancer: a population-based study. Int J Palliat Nurs 2015;21:349–356. doi.org/10.12968/ijpn.2015.21.7.349

    Article  PubMed  Google Scholar 

  23. Rodin MB. Cancer patients admitted to nursing homes: what do we know? J Am Med Dir Assoc 2008;9:149–156. doi.org/10.1016/j.jamda.2007.11.011

    Article  PubMed  Google Scholar 

  24. Monroe TB, Carter MA, Feldt KS, Dietrich MS, Cowan RL. Pain and hospice care in nursing home residents with dementia and terminal cancer. Geriatr Gerontol Int 2013;13:1018–1025. doi.org/10.1111/ggi.12049

    Article  PubMed  PubMed Central  Google Scholar 

  25. Chen I-C, Liu M-L, Twu F-C, Yuan C-H. Use of medication by nursing home residents nearing end of life: a preliminary report. J Nurs Res JNR 2010;18:199–205. doi.org/10.1097/JNR.0b013e3181ed5731

    Article  PubMed  CAS  Google Scholar 

  26. Currow DC, Stevenson JP, Abernethy AP, Plummer J, Shelby-James TM. Prescribing in palliative care as death approaches. J Am Geriatr Soc 2007;55:590–595. doi. org/10.1111/j.1532-5415.2007.01124.x

    Article  PubMed  Google Scholar 

  27. Hunnicutt JN, Ulbricht CM, Tjia J, Lapane KL. Pain and pharmacologic pain management in long-stay nursing home residents. Pain 2017;158:1091–1099. doi. org/10.1097/j.pain.0000000000000887

    Article  PubMed  PubMed Central  Google Scholar 

  28. Takai Y, Yamamoto-Mitani N, Okamoto Y, Koyama K, Honda A. Literature review of pain preva-lence among older residents of nursing homes. Pain Manag Nurs 2010;11:209–223. doi.org/10.1016/j.pmn.2010.08.006

    Article  PubMed  Google Scholar 

  29. Ruggiero C, Lattanzio F, Dell’Aquila G, Gasperini B, Cherubini A. Inappropriate drug prescriptions among older nursing home residents: the Italian perspective. Drugs Aging 2009;26 Suppl 1:15–30. doi.org/10.2165/11534630-000000000-00000

    Article  PubMed  Google Scholar 

  30. Suhrie EM, Hanlon JT, Jaffe EJ, Sevick MA, Ruby CM, Aspinall SL. Impact of a geriatric nursing home palliative care service on unnecessary medication prescribing. Am J Geriatr Pharmacother 2009;7:20–25. doi.org/10.1016/j.amjopharm.2009.02.001

    Article  PubMed  PubMed Central  Google Scholar 

  31. Russell BJ, Rowett D, Abernethy AP, Currow DC. Prescribing for comorbid disease in a palliative population: focus on the use of lipid-lowering medications. Intern Med J 2014;44:177–184. doi.org/10.1111/imj.12340

    Article  PubMed  CAS  Google Scholar 

  32. Jansen K, Schaufel MA, Ruths S. Drug treatment at the end of life: an epidemiologic study in nurs-ing homes. Scand J Prim Health Care 2014;32:187–192. doi.org/10.3109 /02813432.2014.972068

    Article  PubMed  PubMed Central  Google Scholar 

  33. Weschules DJ, Maxwell TL, Shega JW. Acetylcholinesterase inhibitor and N-methyl-D-aspartic acid receptor antagonist use among hospice enrollees with a primary diagnosis of dementia. J Palliat Med 2008;11:738–745. doi.org/10.1089/jpm.2007.0125

    Article  PubMed  Google Scholar 

  34. Herrmann N, Gill SS, Bell CM, Anderson GM, Bronskill SE, Shulman KI, et al. A population-based study of cholinesterase inhibitor use for dementia. J Am Geriatr Soc 2007;55:1517–1523. doi.org/10.1111/j.1532-5415.2007.01377.x

    Article  PubMed  Google Scholar 

  35. Daiello LA, Ott BR, Lapane KL, Reinert SE, Machan JT, Dore DD. Effect of discontinuing cholin-esterase inhibitor therapy on behavioral and mood symptoms in nursing home patients with dementia. Am J Geriatr Pharmacother 2009;7:74–83. doi. org/10.1016/j.amjopharm.2009.04.002

    Article  PubMed  CAS  Google Scholar 

  36. Murray S, Kendall M, Boyd K, Sheikh A. Illness trajectories and palliative care. BMJ 2005;330:1007–1011.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Yourman LC, Lee SJ, Schonberg MA, Widera EW, Smith AK. Prognostic indices for older adults: a systematic review. JAMA 2012;307:182–192. doi.org/10.1001/jama.2011.1966

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  38. Thomas K. THe Gold Standart Framework. Prognostic indicator guidance (PIG). Gold Stand Framew Cent End Life Care CIC Oct;4th Edition, 2011.

    Google Scholar 

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Author information

Authors and Affiliations

  1. Centre Hospitalier Universitaire de Toulouse, Toulouse, France

    S. Sourdet, C. Rochette, F. Nourhashemi, A. Piau, B. Vellas & Y. Rolland

  2. INSERM U1027, Toulouse, France

    P. De Souto Barreto

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  1. S. Sourdet
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  2. C. Rochette
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  3. P. De Souto Barreto
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Correspondence to S. Sourdet.

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Sourdet, S., Rochette, C., De Souto Barreto, P. et al. Drug Prescriptions in Nursing Home Residents during their Last 6 Months of Life: Data from the IQUARE Study. J Nutr Health Aging 22, 904–910 (2018). https://doi.org/10.1007/s12603-018-1071-z

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  • DOI: https://doi.org/10.1007/s12603-018-1071-z

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