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. 2019 Apr 2:12:1178632919834318.
doi: 10.1177/1178632919834318. eCollection 2019.

Opioids, Pain Management, and Palliative Care in a Norwegian Nursing Home From 2013 to 2018

Liv Wergeland Sørbye  1 , Simen A Steindal  2 , Mary H Kalfoss  1 , Olaug E Vibe  3
Affiliations

Opioids, Pain Management, and Palliative Care in a Norwegian Nursing Home From 2013 to 2018

Liv Wergeland Sørbye et al. Health Serv Insights. .

Abstract

In Norway, approximately 50% of older people die in nursing homes (NH). Holistic care and pharmacological management are key factors in quality at the end of life. The purpose of this longitudinal study was to describe the use of opioids in an NH during a 5-year period. We focused on palliative care, symptoms, and suffering during the last 3 days before death. Data were collected from spring 2013 to spring 2018. We used the interRAI assessment instrument annually and when the resident died. We conducted a semi-structured interview with nurses on duty at the deathbed. At the time of death, the residents had an average age of 88.9 years and an average stay of 2.9 years (N = 100). At the first assessment, 19% of the residents used 1 or more type of opioids. On the day of death, 55% had an active prescription for opioids, mainly as subcutaneous injections. The results illustrate the different uses of opioids, including managing pain, dyspnoea, sedation, for comfort, as a prophylaxis, or a combination of reasons. Cancer- and cardiovascular diagnoses were the strongest predictor for using morphine (P < 0.05). Identification of the residents' needs for opioids is a challenge for palliative care nurses, both ethically and legally.

Keywords: Palliative care; interRAI assessment; nursing home; opioids; symptoms.

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Conflict of interest statement

Declaration of conflicting interests:The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Number of subscripted opioids during the first and the last assessment (at death).
Figure 2.
Figure 2.
The reasons for using opioids close to death.
See this image and copyright information in PMC

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