Medication burden in the last week of life among older patients receiving end-of-life care in the United States: 2007 National Home and Hospice Care Survey

Although hospice treatment focuses on pain and symptom management, potential continuation of preventative and disease-modifying therapies may put hospice patients at risk of polypharmacy.  This study presents descriptive findings on medication use during the last week of life among a sample of hospice patients with cancer (49%), dementia (12%), debility (14%), heart disease (16%), and lung disease (10%). Our patient sample aged ≥65 (n=2,623) was from the 2007 National Home and Hospice Care Survey.  Medication data were obtained from hospice staff who were asked, “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? Please include any standing, routine, or PRN medications.” Overall, the average number of medications taken was 10.2 (from 9.5 among dementia patients to 11.4 among lung disease patients). Common medications included analgesics (98%), antiemetics/antivertigos (78%), anxiolytics/sedatives/hypnotics (76%), and anticonvulsants (71%). About one-quarter of patients took proton pump inhibitors, anticoagulants, and antidepressants.  Less than 20% took antacids and antibiotics. More cancer patients took opioid analgesics than dementia and debility patients. Heart disease patients tended to take diuretics, while lung disease patients tended to take bronchodilators. More dementia and debility patients took antidepressants than cancer and lung disease patients. The data suggest that older hospice patients take a high number of medications in the last week of life and differences in medication use support individualized care plans. It is unclear how this medication burden affects quality of end-of-life care.