S Sourdet, Centre Hospitalier Universitaire de Toulouse, France,
J Nutr Health Aging. 2018;22(8):904-910. doi: 10.1007/s12603-018-1071-z.
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.
Prospective study.
175 nursing homes in France.
6275 residents were included from May to June 2011.
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.
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).
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.
评估养老院（NH）居民在死亡前 6 个月的药物处方，并评估 NH 工作人员对“预期寿命低于 6 个月”的认识对处方的影响。
前瞻性研究。
法国 175 家养老院。
2011 年 5 月至 6 月期间共纳入 6275 名居民。
将在 6 个月内死亡的居民的初始药物处方与未死亡的居民进行比较。在 6 个月内死亡的居民中，比较了被认为处于生命末期的居民和未被认为处于生命末期的居民的药物处方。使用 Laroche 标准和一组被认为在生命末期不适当的治疗方法来分析潜在不适当的处方（PIP）。
498 名（7.9%）居民在纳入后 6 个月内死亡：他们接受的治疗方案明显更多（8.3 ± 3.8 与 7.9 ± 3.5，p=0.048）。在 6 个月内死亡的 61 名居民被 NH 工作人员视为“生命末期居民”（12.2%）。他们接受的药物明显减少（6.4 ± 4.2 与 8.5 ± 3.6，p<0.001），比未被认定为生命末期的 NH 居民少。他们更常开具阿片类药物（p<0.001），较少使用抗精神病药物（p<0.001）、降脂药物（p=0.006）或降压治疗（p<0.01）。他们还接受了更多的 PIP（59.0%至少接受了一种不适当的处方，与 87.2%相比，p<0.001）。
相当一部分养老院居民接受了 PIP。在被认定为生命末期的患者中，处方的质量似乎有所改善，但仍有一半以上的患者接受了不适当的药物。在这些存在高不良事件风险的患者中，应特别注意处方。
