Objective: To examine drug treatment in nursing home patients at the end of life, and identify predictors of palliative drug therapy.
Design: A historical cohort study.
Setting: Three urban nursing homes in Norway.
Subjects: All patients admitted from January 2008 and deceased before February 2013.
Main outcome measures: Drug prescriptions, diagnoses, and demographic data were collected from electronic patient records. Palliative end-of-life drug treatment was defined on the basis of indication, drug, and formulation.
Results: 524 patients were included, median (range) age at death 86 (19-104) years, 59% women. On the day of death, 99.4% of the study population had active prescriptions; 74.2% had palliative drugs either alone (26.9%) or concomitantly with curative/preventive drugs (47.3%). Palliative drugs were associated with nursing home, length of stay > 16 months (AOR 2.10, 95% CI 1.12-3.94), age (1.03, 1.005-1.05), and a diagnosis of cancer (2.12, 1.19-3.76). Most initiations of palliative drugs and withdrawals of curative/preventive drugs took place on the day of death.
Conclusion: Palliative drug therapy and drug therapy changes are common for nursing home patients on the last day of life. Improvements in end-of-life care in nursing homes imply addressing prognostication and earlier response to palliative needs.
Keywords: Drug therapy; Norway; end of life care; general practice; nursing homes; palliation.