Hospitalisation and use of medication of Danish nursing home residents at the end of life.

INTRODUCTION: The end-of-life period remains sparsely investigated in Danish nursing home residents. This study aimed to estimate medication use, drug reimbursement for terminal illness and hospital admissions and to compare these estimates between two groups of nursing home residents. METHODS: This small-scale observational study was based on residents who died while residing in a nursing home in 2019. Medication use was estimated three months before the residents' death. Estimates for residents registered with a GP designated to the nursing home were compared with estimates for residents who maintained their usual GP. RESULTS: We included 67 residents (mean age: 88 years, 78% female). On average, residents with a designated GP (n = 21) received ten different medications, and residents who maintained their usual GP (n = 46) received seven. In all, 90% of residents were prescribed on average three "often inadequate" medications in their final three months of life. Furthermore, 39 (58%) residents received drug reimbursement for terminal illness; most were residents who maintained their usual GP (65% versus 43%). Among residents who had a designated GP, five (24%) died at the hospital compared with eight (17%) of the residents who maintained their usual GP. CONCLUSIONS: The residents received many drugs, including "often inadequate" medication, in the three months leading up to their death. No significant differences were found between the two groups. A stronger focus should be placed on optimising end-of-life care for nursing home residents. FUNDING: Honoraria received from the Danish Medical Association. TRIAL REGISTRATION: not relevant.

Increased rate of home-death among patients in a Danish general practice.

INTRODUCTION: Most terminally ill patients wish to die at home. The aim of this study was to investigate whether the home-death rate was higher than the Danish average in a general practice with a systematic approach to palliative care and to examine if the number of clinical contacts between the practice and its patients was associated with place of death. METHODS: In a large (6,500 patients) four-doctor general practice outside of Copenhagen, adult patients who died between 2015 and 2018 were identified. Accidental or suicidal deaths were excluded. Data on age, gender, diagnosis, place of death, the primarily responsible physician and the number of clinical contacts during the last four months of life were retrieved from the patients' medical files. RESULTS: A total of 201 patients were included (mean age at time of death = 82.4 years) of whom 99 patients (49%) died at home/in a nursing home and 93 patients (46%) died in hospital/hospice. Compared with regional data, the proportion of home-death was higher in the study population (national (43%, p = 0.09), regional (39%, p = 0.01), municipal (44%, p = 0.18)). The odds of death in hospital were nine times higher if no GP was directly involved in the palliative phase (p = 0.001). However, no significant difference in the number of contacts with the GP between patients who died at home or in hospital/hospice was observed. CONCLUSIONS: The proportion of home-death in the studied general practice was higher than home-death recorded in regional data. Having a GP involved in the palliative phase was associated with home-death independently of the number of GP contacts in the trajectory. FUNDING: The study received funding from the PLU-Fund (Praktiserende Lægers Uddannelsesfond). TRIAL REGISTRATION: not relevant.

Death in nursing homes: a Danish qualitative study.

Little is known about the quality of end-of-life care in Danish nursing homes (NHs). This qualitative descriptive study based on semi-structured group interviews with nursing staff members in three NHs in Copenhagen, Denmark, aimed to describe the participants' perceptions of end-of-life care in Danish NHs, with particular focus on medication administration and collaboration with GPs. Four main categories of problematic issues emerged: medication (problems with 'as needed' medication and lack of knowledge of subcutaneous administration), interpersonal relations (difficulties in cooperation and communication between relatives and GPs), decision making (problems concerning termination of life-prolonging treatment and the need for early planning of end-of-life care), and professional development (documentation and education). Considerable improvements may be achieved primarily by educating and training nursing staff and GPs. More research is warranted to optimise end-of-life care in Danish NHs.

Low confidence among general practitioners in end-of-life care and subcutaneous administration of medicine.

INTRODUCTION: Most terminally ill patients prefer to die at home, and the general practitioner (GP) is central in making this possible. However, knowledge is needed about the GP's level of confidence in assuming this task and with subcutaneous (SC) administration of medicine in end-of-life care. The aim of this study was to determine if GPs used SC needle and medication in end-of-life care, if they felt confident about being principally responsible for palliative trajectories and whether such confidence was associated with GP characteristics. MATERIAL AND METHODS: This was a cross-sectional questionnaire survey of all 332 GPs practising in Copenhagen, Denmark. Questions covered the GPs' use of SC medication/needle and their confidence in being principally responsible for palliative trajectories. RESULTS: The survey response rate was 61%. 43% of the respondents had been principally responsible for a minimum of one palliative trajectory, and only 11% of these GPs had used a SC needle during this process. 57% felt very or somewhat confident being principally responsible and 27% felt very or somewhat confident administrating SC medicine. Confidence as principally responsible was positively associated with the number of palliative trajectories for which the GP had been responsible, but no significant associations with the GPs' age, gender or practice organisation were found. CONCLUSION: We found that few GPs in Copenhagen feel very confident about being responsible for terminal care and that very few used SC needles. Hence, more education and training in this field is warranted. Further research is needed into how GPs may best become involved and supported in end-of-life care. FUNDING: Danish General Practitioners' Educational and Development Fund. TRIAL REGISTRATION: not relevant.