Abstract
Purpose
The quality of dying of the older person could be optimized. One of the cornerstones to achieve better symptom control in the dying patient can be the use of opioids. However, little benchmark data concerning the use and dosage of opioids in the terminal phase in older persons are available.
Methods
In this multi-centric retrospective study, we included patients 75 years and older who died on the acute geriatric unit (AGU) and the palliative care unit (PCU) in three hospitals (during a 2-year period). Sudden deaths were excluded. Demographic and clinical variables, and data concerning use and dosage of opioids in the last 72 h before death were collected.
Results
Data from 556 patients were collected (38.5% from PCU, 61.5% from AGU). Older patients on the PCU were younger and suffered more frequently from end-stage malignancies. Most older patients on PCU (98.2%) received opioids with a mean dosage of 88.2 mg in 72 h. On the AGU, 75.5% of patients was treated with opioids with a mean dosage of 27.7 mg in 72 h. After adjusting for the variables age, gender and underlying pathology, use of opioids (OR 11.9; 95% CI 2.7–51.7; p = 0.022) and dosage (B 28.8; 95% CI 4.1–53.4; p = 0.001) still differed between the PCU and the AGU. Dosage of opioids was also associated with suffering from cancer or not.
Conclusions
This descriptive benchmark study shows that opioids are given to 75.5% of dying older patients on the AGU at a mean dose of 27.7 mg over the last 72 h versus 98.2% and 88.2 mg, respectively, on the PCU. Further prospective studies including detailed information on symptomatology and more in-depth clinical information on trajectory of dying and cause of death are necessary.
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First author (WJ) was responsible for acquisition of data, data analysis and interpretation of data and writing the manuscript. Second (NV) and third (RP) author have had substantial contributions to study concept and design, analysis and interpretation of data, revised the article critically and approved it finally for publication. All authors have read and approved the manuscript.
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Approval of the Medical Ethics Committee of the Ghent University Hospital (Ghent University; reference number OG 017) was obtained on January 17th, 2014.
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The ethics committee decided that consent to participate was not obliged because all subjects were deceased.
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Janssens, W.H., Van Den Noortgate, N.J. & Piers, R.D. Pharmacological treatment in the dying geriatric patient: describing use and dosage of opioids in the acute geriatric wards and palliative care units of three hospitals. Eur Geriatr Med 12, 545–550 (2021). https://doi.org/10.1007/s41999-021-00496-2
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DOI: https://doi.org/10.1007/s41999-021-00496-2