Changes in Prescribing Symptomatic and Preventive Medications in the Last Year of Life in Older Nursing Home Residents

Background: At the end of life goals of care change from disease prevention to symptomatic control, however, little is known about the patterns of medication prescribing at this stage. Objectives: To explore changes in prescribing of symptomatic and preventive medication in the last year of life in older nursing home residents. Methods: A retrospective cohort study was conducted using pharmacy medication supply data of 553 residents from 16 nursing home facilities around Sydney, Australia. Residents received 24-h nursing care, were aged >= 65 years, died between June 2008 and June 2010 and were using at least one medication 1 year before death. Medications were classified as symptomatic, preventive, or other. A linear mixed model was used to compare changes in prescribing in the last year of life. Results: 68.1% of residents were female, mean age was 88.0 (SD: 7.5) years and residents used a mean of 9.1 (SD: 4.1) medications 1 year before death. The mean number of symptomatic medications per resident increased from 4.6 medications 1 year before death to 5.1 medications at death [95% CI 4.4-4.7 to 5.9-5.2, P = 0.000], while preventive medication decreased from 2.0 to 1.4 medications [95% CI 1.9-2.1 to 1.3-1.5, P = 0.000]. Symptomatic medications were used longer in the last year of life, compared to preventive medications (336.3 days [95% CI 331.8-340.8] versus 310.9 days [95% CI 305.2-316.7], P = 0.000). Conclusion: Use of medications for symptom relief increased throughout the last year of life, while medications for prevention of long-term complications decreased. But changes were slight and clinical relevance can be questioned.