Drug use at the end of life in older adults

2019 ◽  
pp. bmjspcare-2018-001614
Author(s):  
Hsien-Yeh Chuang ◽  
Yu-Wen Wen ◽  
Liang-Kung Chen ◽  
Fei-Yuan Hsiao
Keyword(s):  
Older Adults ◽  
Drug Use ◽  
Sudden Death ◽  
Older People ◽  
Organ Failure ◽  
End Of Life ◽  
Outpatient Care ◽  
Symptom Relief ◽  
Cancer Group ◽  
Average Change

ObjectiveTo investigate symptom-relief and comorbid drug uses at the end of life for older people with different dying trajectories (cancer, organ failure, frailty and sudden death) in Taiwan.MethodsIn a retrospective observational study of older people aged 65 years and older who died in hospitals between 2008 and 2012, we used NHIRD to measure numbers, incremental changes and determinants of symptom-relief and comorbid drug use in the last month of outpatient care and last hospitalisation before death.ResultsWe included 59 407 older adults (cancer 37%, organ failure 26%, frailty 35% and sudden death 2%) who died in hospitals for this study. In the last hospitalisation before death, individuals who died of cancer received greatest number of symptom-relief drugs (mean: 4.65, [SD 2.77]) and increased most the average change in the number of symptom-relief drug use (+1.60; SD 3.36). However, individuals who died of organ failure received the highest number of comorbid drugs (mean 2.88, [SD 1.95]) and also increased most the average change in the number of comorbid drug use (+0.17; SD 2.28) at last hospitalisation. Different dying trajectories were key determinants of receiving symptom-relief and comorbid drugs in our study.ConclusionsOur study suggests that the drug use of older adults at the end of life in the cancer group is different from that in the organ failure and frailty groups. Policymakers and health professionals should consider the different strategies to optimise drug use for older people with different dying trajectories near their end of life.

scholarly journals Drug Use in Older Adults with Amyotrophic Lateral Sclerosis Near the End of Life

Drugs & Aging ◽  
2017 ◽  
Vol 34 (7) ◽  
pp. 529-533 ◽  
Author(s):  
Giulia Grande ◽  
Lucas Morin ◽  
Davide Liborio Vetrano ◽  
Johan Fastbom ◽  
Kristina Johnell
Keyword(s):  
Older Adults ◽  
Amyotrophic Lateral Sclerosis ◽  
Drug Use ◽  
End Of Life ◽  
Lateral Sclerosis

Palliative care during the final week of life of older people in nursing homes: A register-based study

2017 ◽  
Vol 15 (4) ◽  
pp. 417-424 ◽  
Author(s):  
Jonas Smedbäck ◽  
Joakim Öhlén ◽  
Kristofer Årestedt ◽  
Anette Alvariza ◽  
Carl-Johan Fürst ◽  
...  
Keyword(s):  
Palliative Care ◽  
Nursing Home ◽  
Nursing Homes ◽  
Older People ◽  
End Of Life ◽  
Pain Treatment ◽  
Symptom Relief ◽  
Individual Characteristics ◽  
Shortness Of Breath ◽  
Prevalent Symptom

ABSTRACTObjective:Our aim was to explore the presence of symptoms, symptom relief, and other key aspects of palliative care during the final week of life among older people residing in nursing homes.Method:Our study employed data from the Swedish Palliative Care Register on all registered individuals aged 60 and older who had died in nursing homes during the years 2011 and 2012. Variables pertaining to monitoring and treatment of symptoms, end-of-life discussions, circumstances around the death, and the individual characteristics of deceased individuals were explored using descriptive statistics.Results:The most common underlying causes of death among the 49,172 deceased nursing home residents were circulatory diseases (42.2%) and dementia (22.7%). The most prevalent symptom was pain (58.7%), followed by rattles (42.4%), anxiety (33.0%), confusion (21.8%), shortness of breath (14.0%), and nausea (11.1%). Pain was the symptom with the highest degree of total relief (46.3%), whereas shortness of breath and confusion were totally relieved in 6.1 and 4.3% of all individuals, respectively. The use of valid instruments for symptom assessment was reported for pain in 12.3% and for other symptoms in 7.8% of subjects. The most prevalent individual prescriptions for injection PRN (pro re nata, according to circumstances) were for pain treatment (79.5%) and rattles (72.8%). End-of-life discussions were performed with 27.3% of all the deceased individuals and with 53.9% of their relatives. Of all individuals, 82.1% had someone present at death, and 15.8% died alone. Of all the nursing home resident deaths recorded, 45.3% died in their preferred place.Significance of results:There were large variations in degree of relief from different symptoms during the final week of life. Pain was the most prevalent symptom, and it was also the symptom with the highest proportion of total/partial relief. Other symptoms were less prevalent but also less well-relieved. Our results indicate a need for improvement of palliative care in nursing home settings, focusing on management of distressing symptoms and promotion of end-of-life discussions.

scholarly journals End of life care for frail older people; do we have a consensus guideline on deprescribing?

2021 ◽  
Author(s):  
Arjun Poudel ◽  
Shakti Shrestha ◽  
Anna Lukacisinova ◽  
Lisa Nissen
Keyword(s):  
Older Adults ◽  
Life Expectancy ◽  
Older People ◽  
End Of Life ◽  
End Of Life Care ◽  
Life Care ◽  
Frail Older People ◽  
Limited Life Expectancy ◽  
Limited Life ◽  
Medication Appropriateness

Background: Deprescribing interventions have shown to improve medication appropriateness in older people. However, the evidence on the actual benefits and risks of deprescribing in older adults at the end of life are limited. Due to the lack of evidence on the safety and efficacy of medication in these populations, the most appropriate deprescribing approach is unclear. We aimed to conduct a narrative review of research on existing deprescribing guidelines targeted to frail older people at the end of life. Methods: A literature search was conducted in PubMed, Embase, CINAHL and Google Scholar to identify studies from inception to January 2021 on deprescribing guidelines/tools for frail older adults near end-of-life or palliative situation or life-limiting illnesses or limited life expectancy were included. Results: A total of nine studies were included. The deprescribing guidelines used in these studies were helpful to some extent in optimising medications in patients with limited life expectancy and life-limiting illnesses. Some of them have been tested in prospective studies that showed their usefulness in minimising the number of potentially inapproapriate medications. These studies however were not randomised and involved small sample sizes and had little insight into the clinical outcomes of using these tools. Conclusions: The existing tools and guidelines on deprescribing do not represent the end of life care nor address the medication appropriateness among individuals with a specific condition. An explicit and rigorous consensus-based guideline needs to be developed and tested in a well-designed clinical trial to measure clinically significant outcomes

scholarly journals Medications and Falls Experiences among Older People

2021 ◽  
Vol 23 (4) ◽  
pp. 373-383
Author(s):  
Jiyoon Han ◽  
Eunok Park
Keyword(s):  
Older Adults ◽  
Drug Use ◽  
Older People ◽  
Community Dwelling ◽  
Narcotic Analgesics ◽  
Sleeping Pills ◽  
Raising Awareness ◽  
The Status ◽  
Medication Reviews ◽  
Fall Risks

Purpose: This study aimed to identify the status of drug use and analyze the effects of drug use on falls among older people.Methods: The data were collected from 285 community-dwelling older persons through interviewing with questionnaires and checking participants’ medication prescriptions and the drugs using the Korea Pharmaceutical Information Center’s (KPIC) website. The medications were classified into anatomical and therapeutic divisions based on the medications’ ingredients provided by the KPIC. x2 test, ANOVA, t-test, and logistic regressions were applied to analyze the data.Results: The finding showed that 81.4% of the older adults were taking medications. Older people taking antihyperlipidemic drugs were at 1.79 times higher risk for experiencing a fall (95% CI=1.01~3.16, p=.046), and hypnotic sedative and sleeping pills increased their fall risks 11.06 times (95% CI=1.27~96.07, p=.029) compared to those not taking the medications. Nonsteroidal antiinflammatory agents showed a 2.74 odds ratio (95% CI=1.23~5.73, p=.013) and narcotic analgesics increased the fall experience risk 8.56 times (95% CI=1.02~71.88, p=.048). Those with chronic diseases experienced falls 3.04 times more than those without chronic diseases.Conclusion: The study findings showed medications might be one of the important influencing factors on fall risks among older adults. Raising awareness of fall risks associated with medicines through health education and medication reviews by health professionals should be considered a strategy for preventing older adults' falls.

scholarly journals Frailty degree and illness trajectories in older people towards the end-of-life: a prospective observational study

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e042645
Author(s):  
Jordi Amblàs-Novellas ◽  
Scott A Murray ◽  
Ramon Oller ◽  
Anna Torné ◽  
Joan Carles Martori ◽  
...  
Keyword(s):  
Observational Study ◽  
Older People ◽  
Organ Failure ◽  
End Of Life ◽  
Prospective Observational Study ◽  
Cox Regression ◽  
Rank Test ◽  
Illness Trajectory ◽  
Risk Of Death ◽  
People With Dementia

ObjectivesTo assess the degree of frailty in older people with different advanced diseases and its relationship with end-of-life illness trajectories and survival.MethodsProspective, observational study, including all patients admitted to the Acute Geriatric Unit of the University Hospital of Vic (Spain) during 12 consecutive months (2014–2015), followed for up to 2 years. Participants were identified as end-of-life people (EOLp) using the NECPAL (NECesidades PALiativas, palliative care needs) tool and were classified according to their dominant illness trajectory. The Frail-VIG index (Valoración Integral Geriátrica, Comprehensive Geriatric Assessment) was used to quantify frailty degree, to calculate the relationship between frailty and mortality (Receiver Operating Characteristic (ROC) curves), and to assess the combined effect of frailty degree and illness trajectories on survival (Cox proportional hazards model). Survival curves were plotted using the Kaplan-Meier estimator with participants classified into four groups (ie, no frailty, mild frailty, moderate frailty and advanced frailty) and were compared using the log-rank test.ResultsOf the 590 persons with a mean (SD) age of 86.4 (5.6) years recruited, 260 (44.1%) were identified as EOLp, distributed into cancer (n=31, 11.9%), organ failure (n=79, 30.4%), dementia (n=86, 33.1%) and multimorbidity (n=64, 24.6%) trajectories. All 260 EOLp had some degree of frailty, mostly advanced frailty (n=184, 70.8%), regardless of the illness trajectory, and 220 (84.6%) died within 2 years. The area under the ROC curve (95% CI) after 2 years of follow-up for EOLp was 0.87 (0.84 to 0.92) with different patterns of survival decline in the different end-of-life trajectories (p<0.0001). Cox regression analyses showed that each additional deficit of the Frail-VIG index increased the risk of death by 61.5%, 30.1%, 29.6% and 12.9% in people with dementia, organ failure, multimorbidity and cancer, respectively (p<0.01 for all the coefficients).ConclusionsAll older people towards the end-of-life in this study were frail, mostly with advanced frailty. The degree of frailty is related to survival across the different illness trajectories despite the differing survival patterns among trajectories. Frailty indexes may be useful to assess end-of-life older people, regardless of their trajectory.

End-of-Life Care for Older Adults in ICUs

2002 ◽  
Vol 20 (1) ◽  
pp. 181-229 ◽  
Author(s):  
JUDITH G. BAGGS
Keyword(s):  
Older Adults ◽  
Intensive Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Life Support ◽  
Symptom Relief ◽  
Life Support Care ◽  
Life Care ◽  
Care Providers ◽  
Care Needs

This review was undertaken to present and critique the most recent (1990-2000) empirical evidence about end-of-life care for older adult patients in ICUs, their families, and care providers. The studies (including descriptive, correlational, longitudinal, and intervention) were found using a combination of these terms: (a) intensive care (units) or critical care (units), and (b) critical illness, critically ill patients, terminally ill, terminal care, life support care, or palliative care. The computerized databases searched were CINAHL and MEDLINE. Only published studies of persons 44 years of age or older, written in English, and conducted in the U.S. or Canada were included. Research was not limited to studies conducted by or written by nurses. Excluded were articles focused on physiology, for example, studies of treatment for specific conditions, and articles focused on predictors of ICU outcomes.Findings and Implications for ResearchThere is little research specifically focused on end-of-life care of older adults in ICUs. Most research has been retrospective, and most has involved either providers or patients and families but not both.Research is needed in many areas. The mechanism by which age affects choice of care needs further exploration. The experience of patients, families, and providers and how those experiences change with interventions needs investigation. The influence of the ICU culture, variation in decisions made and reasons for that variation, the decision-making process, and variations in care, all require further attention. Four domains were identified for research needed to improve care for older adults at the end of life in intensive care: symptom relief, communication improvement, psychological support, and relationship improvement. No one has assessed whether the ICU is a good place for transition to palliation to occur, or whether it would be better to transfer patients to another type of unit.

scholarly journals INTERNET USE AND LONELINESS OF OLDER ADULTS OVER TIME: THE MEDIATION EFFECT OF SOCIAL CONTACT

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S194-S194
Author(s):  
Kexin Yu ◽  
Kexin Yu ◽  
Shinyi Wu ◽  
Iris Chi
Keyword(s):  
Older Adults ◽  
Older People ◽  
Internet Use ◽  
Social Contact ◽  
Total Effect ◽  
Mediation Effect ◽  
Health And Retirement Study ◽  
Longitudinal Association ◽  
Retirement Study ◽  
Over Time

Abstract Internet is increasingly popular among older adults and have changed interpersonal interactions. However, it remains controversial whether older people are more or less lonely with internet use. This paper tests the longitudinal association of internet use and loneliness among older people. One pathway that explains the association, the mediation effect of social contact, was examined. Data from the 2006, 2010 and 2014 waves of Health and Retirement Study was used. Hierarchical liner modeling results showed internet use was related to decreased loneliness over 12-year period of time (b=-0.044, p&lt;.001). Internet use was associated with more social contact with family and friends overtime (b=0.261, p&lt;.001), social contact was related to less perceived loneliness longitudinally (b=0.097, p&lt;.001). The total effect of internet use on loneliness is -0.054 and the mediated effect is -0.025. The findings imply that online activities can be effective for reducing loneliness for older people through increased social contact.

scholarly journals Service Delivery Models to Maximize Quality of Life for Older People at the End of Life: A Rapid Review

2019 ◽  
Vol 97 (1) ◽  
pp. 113-175 ◽  
Author(s):  
CATHERINE J. EVANS ◽  
LUCY ISON ◽  
CLARE ELLIS‐SMITH ◽  
CAROLINE NICHOLSON ◽  
ALESSIA COSTA ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Service Delivery ◽  
Older People ◽  
End Of Life ◽  
Rapid Review ◽  
Service Delivery Models ◽  
Delivery Models

scholarly journals Engagement in Advance Care Planning: The Association With Cognitive Impairment and Care Preferences

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 417-418
Author(s):  
Hyo Jung Lee ◽  
Giyeon Kim
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Relative Risk ◽  
End Of Life ◽  
Advance Care Planning ◽  
Multinomial Logistic Regression ◽  
Quality Care ◽  
Care Planning ◽  
Advance Care ◽  
Four Levels

Abstract Although there has been growing evidence that Advance care planning (ACP) benefits people with cognitive impairment nearing death, our understanding about this issue is still limited. This study examines whether cognitive impairment is associated with ACP engagement and end-of-life care preferences among older adults in the U.S. Using data from the 2012 National Health and Trends Study (n=1798, aged 65 to 101), we identified four levels of ACP engagement: None (28%), Informal ACP conversation only (12%), Formal ACP only (14%), and Both informal and formal ACP (46%). Older adults with None showed the highest prevalence of having cognitive impairment (17%), followed by those with Formal ACP only (15%) and the other two (6%, 6%). The results of Multinomial Logistic Regression showed that, compared to those without, respondents with cognitive impairment had 143% increased relative risk of having None (RR = 2.43, CI: 1.58-3.73) and 81% increased relative risk of completing Formal ACP only (RR = 1.81, CI: 1.11-2.95) relative to completing Both informal and formal ACP. In addition, respondents with None were more likely to prefer to receive all treatments available nearing death than those with any ACP engagement. Achieving high quality care at the end of life can be more challenging for older adults with cognitive impairment and their family caregivers due to the limited capacity. Although encouraged, informal ACP conversation with loved ones does not necessarily occur before the formal ACP, especially, for those with cognitive impairment. Therefore, they may merit more attention such as early ACP engagement.

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