Use of medication by nursing home residents nearing end of life: a preliminary report.

BACKGROUND

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.

PURPOSE

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.

METHODS

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.

RESULTS

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.