Concomitant opioid-laxative use in hospice patients age 65+ in their last week of life: 2007 national home and hospice care survey results
Tuesday, November 5, 2013
: 1:06 p.m. - 1:18 p.m.
Prophylactic use of laxatives in patients on opioids is a key quality indicator recommended to prevent opioid-induced constipation. This study examines concomitant opioid-laxative use during the last week of life among elderly hospice patients with one of the top five common primary diagnoses: cancer, dementia, debility, heart disease, or lung disease. Our sample of hospice patients age ≥65 (n=2,732) was from the 2007 National Home and Hospice Care Survey. Opioid and laxative use was determined by responses to the question, "What are the names of all the medications and drugs the patient was taking seven days prior to and on the day of his/her death while in hospice?", and coded using the Multum classification system. Of the 2,426 patients on opioids, 1,250 (53.6%) used laxatives. While opioid use was highest in patients with cancer (94.2%) and lowest with dementia (81.1%, p<0.001), the proportions of opioid-laxative users did not differ significantly by primary diagnosis. Multivariate analysis indicated that White patients had higher odds than other races (OR=1.96, p=0.009) of concomitant opioid-laxative use, as did patients enrolled in hospice for >7 days compared to those enrolled for fewer days (OR=2.00, p<0.001). Opioid users in private (OR=1.67, p=0.012) or long-term care settings (OR=2.04, p=0.001) had greater odds of taking laxatives than those in hospice inpatient/hospital/other settings. In summary, slightly over one-half of elderly hospice patients had concomitant opioid-laxative use during their last week of life. The data suggest differences in use by race, length of hospice enrollment, and setting of care.
Public health or related research
Explain why prophylactic use of laxatives in patients on opioids is a hospice key quality indicator. Discuss the magnititude of concomitant opioid-laxatic use among home hospice patients age 65+ during the last week of life based on data from the 2007 National Home and Hospice Care Survey. List risk factors that may be associated with concomitant use of opioids and laxatives.
Keyword(s): End-of-Life Care, Prescription Drug Use Patterns
Presenting author's disclosure statement:
Qualified on the content I am responsible for because: I have studied prescription medication management issues in end-of-life care for over 6 years. I am deputy director of the division at CDC's National Center for Health Statistics that administers a family of health provider surveys, including the National Home and Hospice Care Survey.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines,
and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed
in my presentation.