• Claire Hewer, Edward Richfield, Carmen Halton, and Jane Alty.
• Pallitative Care Department (C.H., C.H.), Royal Hobart Hospital, Hobart, Tasmania, Australia; Palliative Care Department (C.H.), Christchurch Hospital, Christchurch, New Zealand. Electronic address: claire.hewer@ths.tas.gov.au.
• J Pain Symptom Manage. 2024 Feb 1; 67 (2): e121e128e121-e128.

BackgroundEnd-of-life (EOL) care for Parkinson's disease (PD) can be challenging when oral medications are no longer tolerated.MeasuresTo assess EOL prescribing for people with PD (PWP), focusing on rotigotine dosing and proxy measures of distress: benzodiazepine and opioid use.InterventionA retrospective audit of patient records from PWP who died between January 2019 and May 2022 at the Royal Hobart Hospital (RHH), Australia, was conducted. Data was systematically collated on demographics, symptoms, levodopa equivalent daily dose (LEDD) and rotigotine, oral morphine equivalent (OME) and benzodiazepine doses in the last 72 hours of life .OutcomesPain (72%), respiratory secretions (66%) and agitation (66%) were the most documented EOL symptoms. 83% (n = 52) of PWP were eligible for rotigotine and, of those, 13% (n = 7) received the correct dose, 38% (n = 20) a lower dose, 12% (n = 6) a higher dose and 37% (n = 19) did not receive any. Rotigotine dose was positively associated with total (P = 0.016) and PRN (P = 0.037) benzodiazepine dose. LEDD was positively associated with total benzodiazepine (P = 0.018) and total OME dose (P = 0.046). Contraindicated dopamine antagonists were prescribed for 43% of PWP and administered in 31% of those cases.ConclusionsRotigotine dose and admission LEDD were both associated with proxy measures of distress in the last 72 hours of life. This suggests cautious use of rotigotine at EOL. LEDD may help identify patients at risk of distress. Rates of inappropriate prescribing and symptom prevalence were high, indicating a need for further staff education to optimize the care of PWP.Copyright © 2023 American Academy of Hospice and Palliative Medicine. All rights reserved.

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