Medication use in aged care residents in the last year of life: A scoping review

Abstract

<jats:sec><jats:title>Background:</jats:title><jats:p> A substantial number of older adults die in residential aged care facilities, yet little is known about the characteristics of and how best to optimise medication use in the last year of life. </jats:p></jats:sec><jats:sec><jats:title>Aim:</jats:title><jats:p> The aim of this review was to map characteristics of medication use in aged care residents during the last year of life in order to examine key concepts related to medication safety and draw implications for further research and service provision. </jats:p></jats:sec><jats:sec><jats:title>Design:</jats:title><jats:p> A scoping review following Arskey and O’Malley’s framework was conducted using a targeted keyword search, followed by assessments of eligibility based on title and content of abstracts and full papers. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the scoping review protocol was prospectively registered to the Open Science Framework on 27 November 2018. </jats:p></jats:sec><jats:sec><jats:title>Data Sources:</jats:title><jats:p> We searched MEDLINE, EMBASE, AMED, CINAHL and Cochrane databases to identify peer-reviewed studies published between 1937 and 2018, written in English and looking at medication use in individuals living in aged care facilities within their last year of life. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> A total of 30 papers were reviewed. Five key overarching themes were derived from the analysis process: (1) access to medicines at the end of life, (2) categorisation and classes: medicines and populations, (3) polypharmacy and total medication numbers, (4) use of symptomatic versus preventive medications and (5) ‘inappropriate’ medications. </jats:p></jats:sec><jats:sec><jats:title>Conclusion:</jats:title><jats:p> Number of prescriptions or blunt categorisations of medications to assess their appropriateness are unlikely to be sufficient to promote well-being and medication safety for older people in residential aged care in the final stages of life. </jats:p></jats:sec>

Drug prescribing changes in the last year of life among homebound older adults: national retrospective cohort study

“…The CVPD was discontinued during the last year of life, but the prevalence of these drugs remained high, as also reported in previous studies in older adults at the LLE stage 7 11–14 18–21. These findings might be partly explained by the difficulty of evaluating the benefits and risks, taking into account the time to benefit and the patients’ remaining life expectancy.…”

“…As patients approach their end-of-life stage, the goals of care focus on symptom management and maintaining the quality of life rather than decreasing mortality and morbidity 11. However, balancing the prescription of preventive and symptom management drugs has often been challenging, and preventive drugs are often prescribed in patients with LLE 7 11–14. Certain preventive drugs are potentially inappropriate for such patients, given that the time to benefit may be longer than their remaining life expectancies 15 16.…”

Neglecting the care of older people in residential care settings: A national document analysis of complaints reported to the Finnish supervisory authority

“…The finding that the complaints mainly focused on neglecting older people's basic care needs is crucial. Neglecting daily nutrition, activities (Saarela et al., 2017), observing symptoms and medication (Aitken et al., 2020; Halonen et al., 2019; Resnick et al., 2018) have been reported to endanger older people's rights to have their comprehensive care needs met (World Health Organization (WHO), 2017). It is noteworthy that nurses have reported to have limited awareness (Myhre et al., 2020) and competencies to identify different forms of neglect in older people's care in residential settings (Bloemen et al., 2015; McCool et al., 2009; Myhre et al., 2020; Reader & Gillespie, 2013; Winterstein, 2012).…”

Good medicines management: From describing problems to a vision for change

“… 7 Delays in prescribing, supply of medication from pharmacies and delivery of medicines are common. 8 This is especially concerning given the increasing trend to care for the dying outside of hospitals.…”

“…To develop an evidence-base for best practice in the ‘unattended to’ aspects of medicines management in palliative care, for example, making decisions to act – whether, for example, for carers to summon help with symptom control, nursing staff to administer as required or anticipatory medicines, 2 , 4 , 8 or for a deprescribing review to be completed. 6 …”