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Research
Drug use at the end of life in older adults
  1. Hsien-Yeh Chuang1,2,
  2. Yu-Wen Wen3,
  3. Liang-Kung Chen4,5,6 and
  4. Fei-Yuan Hsiao1,2,7
  1. 1Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
  2. 2Graduate Institute of Clinical Pharmacy, National Taiwan University, Taipei, Taiwan
  3. 3Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan
  4. 4Aging and Health Research Center, National Yang-Ming University, Taipei, Taiwan
  5. 5Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
  6. 6Department of Geriatric Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
  7. 7School of Pharmacy, National Taiwan University, Taipei, Taiwan
  1. Correspondence to Dr Fei-Yuan Hsiao, Graduate Institute of Clinical Pharmacy, National Taiwan University, Taipei, Taiwan; fyshsiao{at}ntu.edu.tw

Abstract

Objective To investigate symptom-relief and comorbid drug uses at the end of life for older people with different dying trajectories (cancer, organ failure, frailty and sudden death) in Taiwan.

Methods In a retrospective observational study of older people aged 65 years and older who died in hospitals between 2008 and 2012, we used NHIRD to measure numbers, incremental changes and determinants of symptom-relief and comorbid drug use in the last month of outpatient care and last hospitalisation before death.

Results We included 59 407 older adults (cancer 37%, organ failure 26%, frailty 35% and sudden death 2%) who died in hospitals for this study. In the last hospitalisation before death, individuals who died of cancer received greatest number of symptom-relief drugs (mean: 4.65, [SD 2.77]) and increased most the average change in the number of symptom-relief drug use (+1.60; SD 3.36). However, individuals who died of organ failure received the highest number of comorbid drugs (mean 2.88, [SD 1.95]) and also increased most the average change in the number of comorbid drug use (+0.17; SD 2.28) at last hospitalisation. Different dying trajectories were key determinants of receiving symptom-relief and comorbid drugs in our study.

Conclusions Our study suggests that the drug use of older adults at the end of life in the cancer group is different from that in the organ failure and frailty groups. Policymakers and health professionals should consider the different strategies to optimise drug use for older people with different dying trajectories near their end of life.

  • end of life care
  • dying trajectories
  • symptom-relief drug
  • comorbid drug
  • drug utilisation

https://doi.org/10.1136/bmjspcare-2018-001614

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    Footnotes

    • Contributors H-YC, Y-WW, L-KC and F-YH contributed to the study concept and design. H-YC and F-YH acquired and analysed the data. H-YC, Y-WW, L-KC and F-YH interpreted the data. H-YC and F-YH drafted the manuscript. L-KC and F-YH revised the manuscript. All authors read and approved the final manuscript.

    • Funding F-YH received research assistantships from a research project (MOST104-2410-H-002-225-MY3) sponsored by the Ministry of Science and Technology, Taiwan. The author had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of their analysis.

    • Disclaimer The funding source had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review, or approval of the manuscript; the decision to submit the manuscript for publication.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval All identifiers for all the entries in the NHRID were encrypted to protect the privacy of the individual patients. The study was approved by the Institutional Review Board of the National Taiwan University Hospital (National Taiwan University Hospital Research Ethics Committee No. 201403069W).

    • Provenance and peer review Not commissioned; externally peer reviewed.