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Potentially inappropriate treatments at the end of life in nursing home residents : findings from the PACE cross-sectional study in 6 European countries

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Abstract
Context Certain treatments are potentially inappropriate when administered to nursing homes residents at the end of life and should be carefully considered. An international comparison of potentially inappropriate treatments allows insight into common issues and country-specific challenges of end-of-life care in nursing homes and helps direct health-care policy in this area. Objectives To estimate the prevalence of potentially inappropriate treatments in the last week of life in nursing home residents and analyze the differences in prevalence between countries. Methods A cross-sectional study of deceased residents in nursing homes (2015) in six European countries: Belgium (Flanders), England, Finland, Italy, The Netherlands, and Poland. Potentially inappropriate treatments included enteral administration of nutrition, parental administration of nutrition, artificial fluids, resuscitation, artificial ventilation, blood transfusion, chemotherapy/radiotherapy, dialysis, surgery, antibiotics, statins, antidiabetics, new oral anticoagulants. Nurses were questioned about whether these treatments were administered in the last week of life. Results We included 1384 deceased residents from 322 nursing homes. In most countries, potentially inappropriate treatments were rarely used, with a maximum of 18.3% of residents receiving at least one treatment in Poland. Exceptions were antibiotics in all countries (between 11.3% in Belgium and 45% in Poland), artificial nutrition and hydration in Poland (54.3%) and Italy (41%) and antidiabetics in Poland (19.7%). Conclusion Although the prevalence of potentially inappropriate treatments in the last week of life was generally low, antibiotics were frequently prescribed in all countries. In Poland and Italy, the prevalence of artificial administration of food/fluids in the last week of life was high, possibly reflecting country differences in legislation, care organization and culture, and the palliative care competences of staff.
Keywords
Potentially inappropriate treatments, Nursing homes, End-of-life care, Europe

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Citation

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MLA
Honinx, Elisabeth, et al. “Potentially Inappropriate Treatments at the End of Life in Nursing Home Residents : Findings from the PACE Cross-Sectional Study in 6 European Countries.” JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 61, no. 4, 2021, pp. 732-742e1, doi:10.1016/j.jpainsymman.2020.09.001.
APA
Honinx, E., Van den Block, L., Piers, R., Van Kuijk, S. M. J., Onwuteaka-Philipsen, B. D., Payne, S. A., … on behalf of PACE, [ missing ]‎. (2021). Potentially inappropriate treatments at the end of life in nursing home residents : findings from the PACE cross-sectional study in 6 European countries. JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, 61(4), 732-742e1. https://doi.org/10.1016/j.jpainsymman.2020.09.001
Chicago author-date
Honinx, Elisabeth, Lieve Van den Block, Ruth Piers, Sander M.J. Van Kuijk, Bregje D. Onwuteaka-Philipsen, Sheila A. Payne, Katarzyna Szczerbińska, et al. 2021. “Potentially Inappropriate Treatments at the End of Life in Nursing Home Residents : Findings from the PACE Cross-Sectional Study in 6 European Countries.” JOURNAL OF PAIN AND SYMPTOM MANAGEMENT 61 (4): 732-742e1. https://doi.org/10.1016/j.jpainsymman.2020.09.001.
Chicago author-date (all authors)
Honinx, Elisabeth, Lieve Van den Block, Ruth Piers, Sander M.J. Van Kuijk, Bregje D. Onwuteaka-Philipsen, Sheila A. Payne, Katarzyna Szczerbińska, Giovanni G. Gambassi, Harriet Finne-Soveri, Luc Deliens, Tinne Smets, and [ missing ]‎ on behalf of PACE. 2021. “Potentially Inappropriate Treatments at the End of Life in Nursing Home Residents : Findings from the PACE Cross-Sectional Study in 6 European Countries.” JOURNAL OF PAIN AND SYMPTOM MANAGEMENT 61 (4): 732-742e1. doi:10.1016/j.jpainsymman.2020.09.001.
Vancouver
1.
Honinx E, Van den Block L, Piers R, Van Kuijk SMJ, Onwuteaka-Philipsen BD, Payne SA, et al. Potentially inappropriate treatments at the end of life in nursing home residents : findings from the PACE cross-sectional study in 6 European countries. JOURNAL OF PAIN AND SYMPTOM MANAGEMENT. 2021;61(4):732-742e1.
IEEE
[1]
E. Honinx et al., “Potentially inappropriate treatments at the end of life in nursing home residents : findings from the PACE cross-sectional study in 6 European countries,” JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, vol. 61, no. 4, pp. 732-742e1, 2021.
@article{8675456,
  abstract     = {{Context
Certain treatments are potentially inappropriate when administered to nursing homes residents at the end of life and should be carefully considered. An international comparison of potentially inappropriate treatments allows insight into common issues and country-specific challenges of end-of-life care in nursing homes and helps direct health-care policy in this area.
Objectives
To estimate the prevalence of potentially inappropriate treatments in the last week of life in nursing home residents and analyze the differences in prevalence between countries.
Methods
A cross-sectional study of deceased residents in nursing homes (2015) in six European countries: Belgium (Flanders), England, Finland, Italy, The Netherlands, and Poland. Potentially inappropriate treatments included enteral administration of nutrition, parental administration of nutrition, artificial fluids, resuscitation, artificial ventilation, blood transfusion, chemotherapy/radiotherapy, dialysis, surgery, antibiotics, statins, antidiabetics, new oral anticoagulants. Nurses were questioned about whether these treatments were administered in the last week of life.
Results
We included 1384 deceased residents from 322 nursing homes. In most countries, potentially inappropriate treatments were rarely used, with a maximum of 18.3% of residents receiving at least one treatment in Poland. Exceptions were antibiotics in all countries (between 11.3% in Belgium and 45% in Poland), artificial nutrition and hydration in Poland (54.3%) and Italy (41%) and antidiabetics in Poland (19.7%).
Conclusion
Although the prevalence of potentially inappropriate treatments in the last week of life was generally low, antibiotics were frequently prescribed in all countries. In Poland and Italy, the prevalence of artificial administration of food/fluids in the last week of life was high, possibly reflecting country differences in legislation, care organization and culture, and the palliative care competences of staff.}},
  author       = {{Honinx, Elisabeth and Van den Block, Lieve and Piers, Ruth and Van Kuijk, Sander M.J. and Onwuteaka-Philipsen, Bregje D. and Payne, Sheila A. and Szczerbińska, Katarzyna and Gambassi, Giovanni G. and Finne-Soveri, Harriet and Deliens, Luc and Smets, Tinne and on behalf of PACE, [ missing ]‎}},
  issn         = {{0885-3924}},
  journal      = {{JOURNAL OF PAIN AND SYMPTOM MANAGEMENT}},
  keywords     = {{Potentially inappropriate treatments,Nursing homes,End-of-life care,Europe}},
  language     = {{eng}},
  number       = {{4}},
  pages        = {{732--742e1}},
  title        = {{Potentially inappropriate treatments at the end of life in nursing home residents : findings from the PACE cross-sectional study in 6 European countries}},
  url          = {{http://dx.doi.org/10.1016/j.jpainsymman.2020.09.001}},
  volume       = {{61}},
  year         = {{2021}},
}

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