Nursing home hospice patients are not receiving adequate treatment for nonpain symptoms
Research Activities, January 2011, No. 365
While pain control is often a common problem for end-of-life patients in nursing homes, there are other nonpain symptoms that pose similar challenges. These include constipation from the use of narcotics, cough, nausea/vomiting, and fever. A new study recently evaluated if these nonpain symptoms are being treated properly and if not, the reasons for undertreatment. It found that while the prevalence of these symptoms was low, more than half of patients with nonpain symptoms were not being treated adequately with medication. Data for the study were obtained from the 2004 National Nursing Home Survey. The group of 303 older nursing home hospice patients were 65 years or age or older. Information from the survey included detailed staff questions on patient medications and the presence or absence of nonpain symptoms.
Most patients were white (91.4 percent) and female (71.9 percent). Nearly half (47.9 percent) were aged 85 or older. Less than a quarter (22 percent) of the 303 patients experienced one or more nonpain symptoms. The three most common of these were constipation, cough, and nausea/vomiting. When the researchers looked at the rates of medication treatment, more than half (60 percent) of the 82 patients with nonpain symptoms were being undertreated. The highest rate of undertreatment (88 percent) was for nausea/vomiting. Compared with treated patients, those undertreated tended to have significantly more problems with mobility, mood, pressure ulcers, and more secondary diagnoses. Undertreated patients also had shorter length of stays compared with their treated peers.
According to the researchers, more quality improvement initiatives are needed that move beyond just the management of pain to helping patients with these important nonpain symptoms. The study was supported in part by the Agency for Healthcare Research and Quality (HS17695).
See "A cross-sectional analysis of the prevalence of undertreatment of nonpain symptoms and factors associated with undertreatment in older nursing home hospice/palliative care patients," by Keri L. Rodriguez, Ph.D., Joseph T. Hanlon, Pharm.D., M.S., Subashan Perera, Ph.D., and others in the June 2010 American Journal of Geriatric Pharmacotherapy 8(3), pp. 225-232.