Department of Physical Medicine and Rehabilitation, Ton-Yen General Hospital, Taiwan.
J Nurs Res. 2010 Sep;18(3):199-205. doi: 10.1097/JNR.0b013e3181ed5731.
Nursing home residents usually suffer from a variety of medical conditions and are prescribed a wider variety of medications than any other subpopulation. Polypharmacy is associated with the occurrence of adverse events.
The purposes of this study were to describe the medication prescription patterns of residents who died in a nursing home, to examine how this pattern changed as residents progressed toward death, and to identify correlates of increased medication prescriptions.
Thirty-one residents who had lived at one nursing home for more than 6 months before death were included in the study. Medication records for participants were obtained at four data collection points: on admission, 6 months before death, 3 months before death, and at death.
The mean number of medications prescribed immediately before death was 7.90 (SD = 3.27), and there was an upward trend in number of prescriptions written as patients neared death. The most frequent prescription was for medication for constipation, pulmonary care, and hypertension. There was a significant correlation between residents with heart disease and increased medication use. Medication prescribed for pulmonary care and hypertension increased from admission to death, but a decreased use of medication for pain relief in the time before death in these cases was found.
CONCLUSIONS/IMPLICATIONS FOR PRACTICE: This study surveyed and described the pattern of medication use in nursing home residents from admission to the end of life. Results can be used to reinforce clinician and nursing staff awareness of prescription frequency, amounts of medication, and change over time for elderly residents under their care. In addition to safer prescribing practices for the older people, nonpharmacological strategies (e.g., lifestyle modification and physiotherapy for function training) may be used to address common symptoms and complaints during chronic care.
养老院的居民通常患有多种疾病，比其他任何人群开的药都多。多种药物治疗与不良事件的发生有关。
本研究旨在描述在养老院死亡的居民的用药情况，检查随着居民走向死亡，这种模式如何变化，并确定增加用药处方的相关因素。
本研究纳入了在一家养老院居住超过 6 个月后死亡的 31 名居民。在四个数据收集点获取参与者的用药记录：入院时、死亡前 6 个月、死亡前 3 个月和死亡时。
死亡前平均开了 7.90 种（SD = 3.27）药物，随着患者接近死亡，开处方的数量呈上升趋势。最常见的处方是用于治疗便秘、肺部护理和高血压的药物。患有心脏病的居民与增加用药之间存在显著相关性。用于肺部护理和高血压的药物从入院到死亡持续开，但在这些情况下，临终前缓解疼痛的药物使用减少。
结论/对实践的意义：本研究调查并描述了养老院居民从入院到生命结束的用药模式。结果可用于增强临床医生和护理人员对老年人护理人员的处方频率、用药量和随时间变化的认识。除了为老年人提供更安全的处方实践外，还可以使用非药物策略（例如，生活方式改变和物理疗法进行功能训练）来解决慢性护理期间的常见症状和投诉。
