TY - JOUR

T1 - Potentially Inappropriate Treatments at the End of Life in Nursing Home Residents

T2 - Findings From the PACE Cross-Sectional Study in Six European Countries

AU - PACE consortium

AU - Honinx, E.

AU - Van den Block, L.

AU - Piers, R.

AU - Van Kuijk, S.M.J.

AU - Onwuteaka-Philipsen, B.D.

AU - Payne, S.A.

AU - Szczerbińska, K.

AU - Gambassi, G.G.

AU - Finne-Soveri, H.

AU - Deliens, L.

AU - Smets, T.

AU - Gatsolaeva, Y.

AU - Miranda, R.

AU - Pivodic, L.

AU - Tanghe, M.

AU - van Hout, H.

AU - Van Den Noortgate, N.

AU - Froggatt, K.

AU - Pasman, H.R.W.

AU - Baranska, I.

AU - Oosterveld-Vlug, M.

AU - Wichmann, A.B.

AU - Engels, Y.

AU - Vernooij-Dassen, M.

AU - Hockley, J.

AU - Leppäaho, S.

AU - Pautex, S.

AU - Bassal, C.

AU - Mammarella, F.

AU - Mercuri, M.

AU - Rossi, P.

AU - Segat, I.

AU - Stodolska, A.

AU - Adang, E.

AU - Kylänen, M.

AU - Andreasen, P.

AU - Kuitunen-Kaija, O.

AU - Moore, D.C.

AU - Pac, A.

AU - Kijowska, V.

AU - Ten Koppel, M.

AU - van der Steen, J.T.

AU - de Paula, E.M.

N1 - This is the author’s version of a work that was accepted for publication in Journal of Pain and Symptom Management. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Journal of Pain and Symptom Management, ?, ?, 2020 DOI: 10.1016/j.jpainsymman.2020.09.001

PY - 2021/4/22

Y1 - 2021/4/22

N2 - Context: Certain treatments are potentially inappropriate when administered to nursing homes residents at the end of life and should be carefully considered. An international comparison of potentially inappropriate treatments allows insight into common issues and country-specific challenges of end-of-life care in nursing homes and helps direct health-care policy in this area. Objectives: To estimate the prevalence of potentially inappropriate treatments in the last week of life in nursing home residents and analyze the differences in prevalence between countries. Methods: A cross-sectional study of deceased residents in nursing homes (2015) in six European countries: Belgium (Flanders), England, Finland, Italy, The Netherlands, and Poland. Potentially inappropriate treatments included enteral administration of nutrition, parental administration of nutrition, artificial fluids, resuscitation, artificial ventilation, blood transfusion, chemotherapy/radiotherapy, dialysis, surgery, antibiotics, statins, antidiabetics, new oral anticoagulants. Nurses were questioned about whether these treatments were administered in the last week of life. Results: We included 1384 deceased residents from 322 nursing homes. In most countries, potentially inappropriate treatments were rarely used, with a maximum of 18.3% of residents receiving at least one treatment in Poland. Exceptions were antibiotics in all countries (between 11.3% in Belgium and 45% in Poland), artificial nutrition and hydration in Poland (54.3%) and Italy (41%) and antidiabetics in Poland (19.7%). Conclusion: Although the prevalence of potentially inappropriate treatments in the last week of life was generally low, antibiotics were frequently prescribed in all countries. In Poland and Italy, the prevalence of artificial administration of food/fluids in the last week of life was high, possibly reflecting country differences in legislation, care organization and culture, and the palliative care competences of staff. © 2020 American Academy of Hospice and Palliative Medicine

AB - Context: Certain treatments are potentially inappropriate when administered to nursing homes residents at the end of life and should be carefully considered. An international comparison of potentially inappropriate treatments allows insight into common issues and country-specific challenges of end-of-life care in nursing homes and helps direct health-care policy in this area. Objectives: To estimate the prevalence of potentially inappropriate treatments in the last week of life in nursing home residents and analyze the differences in prevalence between countries. Methods: A cross-sectional study of deceased residents in nursing homes (2015) in six European countries: Belgium (Flanders), England, Finland, Italy, The Netherlands, and Poland. Potentially inappropriate treatments included enteral administration of nutrition, parental administration of nutrition, artificial fluids, resuscitation, artificial ventilation, blood transfusion, chemotherapy/radiotherapy, dialysis, surgery, antibiotics, statins, antidiabetics, new oral anticoagulants. Nurses were questioned about whether these treatments were administered in the last week of life. Results: We included 1384 deceased residents from 322 nursing homes. In most countries, potentially inappropriate treatments were rarely used, with a maximum of 18.3% of residents receiving at least one treatment in Poland. Exceptions were antibiotics in all countries (between 11.3% in Belgium and 45% in Poland), artificial nutrition and hydration in Poland (54.3%) and Italy (41%) and antidiabetics in Poland (19.7%). Conclusion: Although the prevalence of potentially inappropriate treatments in the last week of life was generally low, antibiotics were frequently prescribed in all countries. In Poland and Italy, the prevalence of artificial administration of food/fluids in the last week of life was high, possibly reflecting country differences in legislation, care organization and culture, and the palliative care competences of staff. © 2020 American Academy of Hospice and Palliative Medicine

KW - End-of-life care

KW - Europe

KW - Nursing homes

KW - Potentially inappropriate treatments

U2 - 10.1016/j.jpainsymman.2020.09.001

DO - 10.1016/j.jpainsymman.2020.09.001

M3 - Journal article

VL - 61

SP - 732

EP - 742

JO - Journal of Pain and Symptom Management

JF - Journal of Pain and Symptom Management

SN - 0885-3924

IS - 4

ER -