Drug treatment at the end of life: An epidemiologic study in nursing homes
Drug treatment at the end of life: An epidemiologic study in nursing homes
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DOI：
10.3109/02813432.2014.972068
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发表时间：
2014-12-01
影响因子：
2.1
通讯作者：
Ruths, Sabine
中科院分区：
文献类型：
--
作者：
Jansen, Kristian;Schaufel, Margrethe Aase;Ruths, Sabine
客观的。检查疗养院患者临终时的药物治疗情况，并确定姑息药物治疗的预测因素。设计。一项历史队列研究。环境。挪威的三个城市疗养院。科目。所有患者均自 2008 年 1 月入院，并于 2013 年 2 月之前死亡。主要结局指标。从电子病历中收集药物处方、诊断和人口统计数据。姑息性临终药物治疗是根据适应症、药物和配方来定义的。结果。纳入 524 名患者，死亡中位（范围）年龄 86（19-104）岁，其中 59% 为女性。在死亡当天，99.4%的研究人群持有有效处方； 74.2% 的人单独使用姑息药物 (26.9%) 或同时使用治疗/预防药物 (47.3%)。姑息药物与疗养院、住院时间 > 16 个月（AOR 2.10，95% CI 1.12-3.94）、年龄（1.03，1.005-1.05）和癌症诊断（2.12，1.19-3.76）相关。大多数姑息药物的启动和治疗/预防药物的撤药发生在死亡当天。结论。对于生命最后一天的疗养院患者来说，姑息药物治疗和药物治疗改变很常见。疗养院临终关怀的改善意味着解决预测问题和对姑息治疗需求的早期响应。
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.