End-of-Life Care Research Group, Ghent University, Ghent, Belgium.
Department of Geriatrics, Ghent University Hospital, Ghent, Belgium.
Eur J Public Health. 2019 Feb 1;29(1):74-79. doi: 10.1093/eurpub/cky196.
Opioids, antipsychotics and hypnotics are recommended for comfort care in dying. We studied their prescription during the last 3 days in residents deceased in the long-term care facility (LTCF).
In a retrospective, cross-sectional survey in Belgium, England, Finland, Italy, the Netherlands and Poland, LTCFs, selected by proportional stratified random sampling, reported all deaths over the previous 3 months. The nurse most involved in the residents' care reviewed the chart for opioid, antipsychotic and hypnotic prescription, cause of death and comorbidities. Multivariable logistic regression was performed to adjust for resident characteristics.
Response rate was 81.6%. We included 1079 deceased residents in 322 LCTFs. Opioid prescription ranged from 18.5% (95% CI: 13.0-25.8) of residents in Poland to 77.9% (95% CI: 69.5-84.5) in the Netherlands, antipsychotic prescription from 4.8% (95% CI: 2.4-9.1) in Finland to 22.4% (95% CI: 14.7-32.4) in Italy, hypnotic prescription from 7.8% (95% CI: 4.6-12.8) in Finland to 47.9% (95% CI: 38.5-57.3) in the Netherlands. Differences in opioid, antipsychotic and hypnotic prescription between countries remained significant (P < 0.001) when controlling for age, gender, length of stay, cognitive status, cause of death in multilevel, multivariable analyses. Dying from cancer showed higher odds for receiving opioids (OR 3.51; P < 0.001) and hypnotics (OR 2.10; P = 0.010).
Opioid, antipsychotic and hypnotic prescription in the dying phase differed significantly between six European countries. Further research should determine the appropriateness of their prescription and refine guidelines especially for LTCF residents dying of non-cancer diseases.
阿片类药物、抗精神病药和催眠药被推荐用于临终关怀。我们研究了它们在长期护理机构（LTCF）中死亡的居民在最后 3 天的处方情况。
在比利时、英国、芬兰、意大利、荷兰和波兰进行的回顾性、横断面调查中，通过比例分层随机抽样选择 LTCF，报告过去 3 个月内的所有死亡情况。最参与居民护理的护士审查了阿片类药物、抗精神病药和催眠药处方、死亡原因和合并症的图表。进行多变量逻辑回归以调整居民特征。
回应率为 81.6%。我们纳入了 322 家 LCTF 中 1079 名死亡居民。阿片类药物处方范围从波兰的 18.5%（95%CI：13.0-25.8）到荷兰的 77.9%（95%CI：69.5-84.5），抗精神病药物处方从芬兰的 4.8%（95%CI：2.4-9.1）到意大利的 22.4%（95%CI：14.7-32.4），催眠药处方从芬兰的 7.8%（95%CI：4.6-12.8）到荷兰的 47.9%（95%CI：38.5-57.3）。在控制年龄、性别、住院时间、认知状态、多水平、多变量分析中的死亡原因后，各国之间在阿片类药物、抗精神病药和催眠药处方方面的差异仍然显著（P <0.001）。死于癌症的患者接受阿片类药物（OR 3.51；P <0.001）和催眠药（OR 2.10；P = 0.010）的可能性更高。
在临终阶段，六个欧洲国家之间阿片类药物、抗精神病药和催眠药的处方存在显著差异。进一步的研究应确定其处方的适当性，并特别为死于非癌症疾病的 LTCF 居民制定指南。
