Potentially Inappropriate Treatments at the End of Life in Nursing Home Residents: Findings From the PACE Cross-Sectional Study in Six European Countries

Elisabeth Honinx*, Lieve Van den Block, Ruth Piers, Sander M.J. Van Kuijk, Bregje D. Onwuteaka-Philipsen, Sheila A. Payne, Katarzyna Szczerbińska, Giovanni G. Gambassi, Harriet Finne-Soveri, Luc Deliens, Tinne Smets, Yuliana Gatsolaeva, Rose Miranda, Lara Pivodic, Marc Tanghe, Hein van Hout, Nele Van Den Noortgate, Katherine Froggatt, H. Roeline W. Pasman, Ilona BaranskaMariska Oosterveld-Vlug, Anne B. Wichmann, Yvonne Engels, Myrra Vernooij-Dassen, Jo Hockley, Suvi Leppäaho, Sophie Pautex, Catherine Bassal, Federica Mammarella, Martina Mercuri, Paola Rossi, Ivan Segat, Agata Stodolska, Eddy Adang, Marika Kylänen, Paula Andreasen, Outi Kuitunen-Kaija, Danni Collingridge Moore, Agnieszka Pac, Violetta Kijowska, Maud Ten Koppel, Jenny T. van der Steen, Emilie Morgan de Paula

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Context: Certain treatments are potentially inappropriate when administered to nursing homes residents at the end of life and should be carefully considered. An international comparison of potentially inappropriate treatments allows insight into common issues and country-specific challenges of end-of-life care in nursing homes and helps direct health-care policy in this area. Objectives: To estimate the prevalence of potentially inappropriate treatments in the last week of life in nursing home residents and analyze the differences in prevalence between countries. Methods: A cross-sectional study of deceased residents in nursing homes (2015) in six European countries: Belgium (Flanders), England, Finland, Italy, The Netherlands, and Poland. Potentially inappropriate treatments included enteral administration of nutrition, parental administration of nutrition, artificial fluids, resuscitation, artificial ventilation, blood transfusion, chemotherapy/radiotherapy, dialysis, surgery, antibiotics, statins, antidiabetics, new oral anticoagulants. Nurses were questioned about whether these treatments were administered in the last week of life. Results: We included 1384 deceased residents from 322 nursing homes. In most countries, potentially inappropriate treatments were rarely used, with a maximum of 18.3% of residents receiving at least one treatment in Poland. Exceptions were antibiotics in all countries (between 11.3% in Belgium and 45% in Poland), artificial nutrition and hydration in Poland (54.3%) and Italy (41%) and antidiabetics in Poland (19.7%). Conclusion: Although the prevalence of potentially inappropriate treatments in the last week of life was generally low, antibiotics were frequently prescribed in all countries. In Poland and Italy, the prevalence of artificial administration of food/fluids in the last week of life was high, possibly reflecting country differences in legislation, care organization and culture, and the palliative care competences of staff.

Original languageEnglish
Pages (from-to)732-742.e1
JournalJournal of Pain and Symptom Management
Issue number4
Publication statusPublished - Apr 2021

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