Online Program

Analgesic use by primary diagnosis among hospice patients 65 and older during the last week of life: Evidence from the 2007 national home and hospice care survey

Tuesday, November 5, 2013 : 1:18 p.m. - 1:30 p.m.

Joseph Shega, MD, Vitas Innovative Hospice Care, Maitland, FL
Lisa Dwyer, MPH, Division of Health Care Statistics, CDC, National Center for Health Statistics, Hyattsville, MD
Denys T. Lau, PhD, Division of Health Care Statistics, CDC, National Center for Health Statistics, Hyattsville, MD
OBJECTIVE: To describe analgesic use, during the last week of life, among elderly hospice patients who died from cancer, dementia, and debility. METHODS: Data were from the 2007 National Home and Hospice Care Survey. Sample included patients age 65+ with a primary hospice diagnosis of cancer, dementia, or debility. Analgesic use—opioids, NSAIDs, salicylates, and others (e.g., acetaminophen)—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 according to the Multum classification system. T-tests and chi-square statistics were computed to compare analgesic use by diagnosis. RESULTS: There were 1,324 (65.3%) cancer, 329 (16.2%) dementia, and 376 (18.5%) debility patients. Prevalence of any analgesic use was similar among all subgroups: cancer (96.9%), dementia (95.1%), and debility (94.4%), p>0.05. However, more patients with cancer took an opioid (90.2%) than those with dementia (81.1%, p<0.001) and debility (85.4%, p<0.01). NSAID use did not vary significantly by diagnosis. Salicylate use was least common among cancer patients (12.1%) compared to dementia (20.4%, p<0.05) and debility patients (18.5%, p=0.06). Use of other analgesics, including acetaminophen, varied: highest among patients with dementia (66.0%), followed by those with debility (53.4%, p<0.05) and cancer (36.2%, p<0.001). CONCLUSION: Analgesic use was prevalent among hospice patients in their last week of life but fewer patients with non-cancer diagnoses took potent analgesics (i.e, opioids) than patients with cancer.

Learning Areas:

Public health or related research

Learning Objectives:
Explain why the use of different classes of analgesics — opioids, NSAIDs, salicylates, and others (e.g., acetaminophen) — is an important quality of care concern in end-of-life care. Discuss the magnititude of analgesic 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. Describe variation in analgesic use in patients by hospice primary diagnosis.

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.

Back to: 4180.0: End-of-Life Care/Issues