A baseline review of medication provided to older people in nursing care homes in the last month of life

Abstract

Increasing numbers of older people are dying in the nursing care home setting. Little is known about the medication needs of the very old and frail in the last weeks of life and how they might differ from a model of care developed for people dying from cancer. A baseline review of medication in the last month of life was undertaken to try and establish current practice of prescribing for this population. The notes of 48 deceased residents in seven nursing care homes were examined, alongside a questionnaire sent to 67 trained nurses. Subcutaneous prescribing only occurred where specialist palliative care teams had been involved with the residents' care. Syringe drivers were used in 23% of cases; however, only three residents required a syringe driver for more than a day and a half. Nurses' confidence and competence in setting up syringe drivers was varied. The use of syringe drivers may not be the most appropriate way of managing symptoms during the dying phase in very frail and old people.