Concomitant opioid-laxative use in hospice patients age 65+ in their last week of life: 2007 national home and hospice care survey results

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.