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Opioid, antipsychotic and hypnotic use in end of life in long-term care facilities in six European countries : results of PACE

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Abstract
Opioids, antipsychotics and hypnotics are recommended for comfort care in dying. We studied their prescription during the last 3 days in residents deceased in the long-term care facility (LTCF). In a retrospective, cross-sectional survey in Belgium, England, Finland, Italy, the Netherlands and Poland, LTCFs, selected by proportional stratified random sampling, reported all deaths over the previous 3 months. The nurse most involved in the residents care reviewed the chart for opioid, antipsychotic and hypnotic prescription, cause of death and comorbidities. Multivariable logistic regression was performed to adjust for resident characteristics. Response rate was 81.6%. We included 1079 deceased residents in 322 LCTFs. Opioid prescription ranged from 18.5% (95% CI: 13.025.8) of residents in Poland to 77.9% (95% CI: 69.584.5) in the Netherlands, antipsychotic prescription from 4.8% (95% CI: 2.49.1) in Finland to 22.4% (95% CI: 14.732.4) in Italy, hypnotic prescription from 7.8% (95% CI: 4.612.8) in Finland to 47.9% (95% CI: 38.557.3) in the Netherlands. Differences in opioid, antipsychotic and hypnotic prescription between countries remained significant (P < 0.001) when controlling for age, gender, length of stay, cognitive status, cause of death in multilevel, multivariable analyses. Dying from cancer showed higher odds for receiving opioids (OR 3.51; P < 0.001) and hypnotics (OR 2.10; P = 0.010). Opioid, antipsychotic and hypnotic prescription in the dying phase differed significantly between six European countries. Further research should determine the appropriateness of their prescription and refine guidelines especially for LTCF residents dying of non-cancer diseases.
Keywords
NURSING-HOME RESIDENTS, PALLIATIVE CARE, LAST DAYS, DEMENTIA, PAIN, SYMPTOMS, PEOPLE, TRENDS, POPULATION, PREVALENCE

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MLA
Tanghe, Marc, et al. “Opioid, Antipsychotic and Hypnotic Use in End of Life in Long-Term Care Facilities in Six European Countries : Results of PACE.” EUROPEAN JOURNAL OF PUBLIC HEALTH, vol. 29, no. 1, 2019, pp. 74–79.
APA
Tanghe, M., Van Den Noortgate, N., Pivodic, L., Deliens, L., Onwuteaka-Philipsen, B., Szczerbińska, K., … Piers, R. (2019). Opioid, antipsychotic and hypnotic use in end of life in long-term care facilities in six European countries : results of PACE. EUROPEAN JOURNAL OF PUBLIC HEALTH, 29(1), 74–79.
Chicago author-date
Tanghe, Marc, Nele Van Den Noortgate, Lara Pivodic, Luc Deliens, Bregje Onwuteaka-Philipsen, Katarzyna Szczerbińska, Harriet Finne-Soveri, et al. 2019. “Opioid, Antipsychotic and Hypnotic Use in End of Life in Long-Term Care Facilities in Six European Countries : Results of PACE.” EUROPEAN JOURNAL OF PUBLIC HEALTH 29 (1): 74–79.
Chicago author-date (all authors)
Tanghe, Marc, Nele Van Den Noortgate, Lara Pivodic, Luc Deliens, Bregje Onwuteaka-Philipsen, Katarzyna Szczerbińska, Harriet Finne-Soveri, Danni Collingridge-Moore, Giovanni Gambassi, Lieve Van den Block, and Ruth Piers. 2019. “Opioid, Antipsychotic and Hypnotic Use in End of Life in Long-Term Care Facilities in Six European Countries : Results of PACE.” EUROPEAN JOURNAL OF PUBLIC HEALTH 29 (1): 74–79.
Vancouver
1.
Tanghe M, Van Den Noortgate N, Pivodic L, Deliens L, Onwuteaka-Philipsen B, Szczerbińska K, et al. Opioid, antipsychotic and hypnotic use in end of life in long-term care facilities in six European countries : results of PACE. EUROPEAN JOURNAL OF PUBLIC HEALTH. 2019;29(1):74–9.
IEEE
[1]
M. Tanghe et al., “Opioid, antipsychotic and hypnotic use in end of life in long-term care facilities in six European countries : results of PACE,” EUROPEAN JOURNAL OF PUBLIC HEALTH, vol. 29, no. 1, pp. 74–79, 2019.
@article{8577608,
  abstract     = {Opioids, antipsychotics and hypnotics are recommended for comfort care in dying. We studied their prescription during the last 3 days in residents deceased in the long-term care facility (LTCF). 
In a retrospective, cross-sectional survey in Belgium, England, Finland, Italy, the Netherlands and Poland, LTCFs, selected by proportional stratified random sampling, reported all deaths over the previous 3 months. The nurse most involved in the residents care reviewed the chart for opioid, antipsychotic and hypnotic prescription, cause of death and comorbidities. Multivariable logistic regression was performed to adjust for resident characteristics. 
Response rate was 81.6%. We included 1079 deceased residents in 322 LCTFs. Opioid prescription ranged from 18.5% (95% CI: 13.025.8) of residents in Poland to 77.9% (95% CI: 69.584.5) in the Netherlands, antipsychotic prescription from 4.8% (95% CI: 2.49.1) in Finland to 22.4% (95% CI: 14.732.4) in Italy, hypnotic prescription from 7.8% (95% CI: 4.612.8) in Finland to 47.9% (95% CI: 38.557.3) in the Netherlands. Differences in opioid, antipsychotic and hypnotic prescription between countries remained significant (P < 0.001) when controlling for age, gender, length of stay, cognitive status, cause of death in multilevel, multivariable analyses. Dying from cancer showed higher odds for receiving opioids (OR 3.51; P < 0.001) and hypnotics (OR 2.10; P = 0.010). 
Opioid, antipsychotic and hypnotic prescription in the dying phase differed significantly between six European countries. Further research should determine the appropriateness of their prescription and refine guidelines especially for LTCF residents dying of non-cancer diseases.},
  author       = {Tanghe, Marc and Van Den Noortgate, Nele and Pivodic, Lara and Deliens, Luc and Onwuteaka-Philipsen, Bregje and Szczerbińska, Katarzyna and Finne-Soveri, Harriet and Collingridge-Moore, Danni and Gambassi, Giovanni and Van den Block, Lieve and Piers, Ruth},
  issn         = {1101-1262},
  journal      = {EUROPEAN JOURNAL OF PUBLIC HEALTH},
  keywords     = {NURSING-HOME RESIDENTS,PALLIATIVE CARE,LAST DAYS,DEMENTIA,PAIN,SYMPTOMS,PEOPLE,TRENDS,POPULATION,PREVALENCE},
  language     = {eng},
  number       = {1},
  pages        = {74--79},
  title        = {Opioid, antipsychotic and hypnotic use in end of life in long-term care facilities in six European countries : results of PACE},
  url          = {http://dx.doi.org/10.1093/eurpub/cky196},
  volume       = {29},
  year         = {2019},
}

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