• Denys T Lau, Lisa L Dwyer, and Joseph W Shega.
• Division of Health Care Statistics, National Center for Health Statistics, Hyattsville, Maryland.
• J Am Geriatr Soc. 2016 Nov 1; 64 (11): e160-e165.

ObjectivesTo examine laxative use by individuals in hospice who were taking opioids during the last week of life.DesignRetrospective cross-sectional.Setting2007 National Home and Hospice Care Survey.ParticipantsIndividuals in hospice aged 65 and older who were taking opioids during the last week of life (N = 2,825).MeasurementsHospice staff were asked the names of all medications and drugs that participants were taking 7 days before and on the day of death while in hospice, including any standing, routine, or as-needed medications." Medications "used" included medications taken and as-needed medications provided in case a symptom developed. Opioids included all opioid-combination drugs. Laxatives included fibers, lubricants, stimulants, and suppositories.ResultsForty-one percent of participants had cancer as the primary hospice diagnosis, 13% heart disease, 12% debility, 11% dementia, 8% lung disease, and 15% other. Overall, 52% of opioid users used a laxative in the last week of life; the proportions of opioid and laxative users did not differ according to diagnosis. Racial minorities taking opioids had lower odds than white participants (odds ratio (OR) = 0.57, 95% confidence interval (CI) = 0.33-0.99) of using laxatives. Participants taking opioids enrolled in hospice for 7 days or less had lower odds of using laxatives than those enrolled for more than 7 days (OR = 0.65, 95% CI = 0.37-0.95), as did those in hospice inpatient, hospital, or other settings (OR = 0.45, 95% CI = 0.43-0.93) than those in long-term care settings. Participants using five or fewer medications had lower odds of using laxatives than those using six to 10 (OR = 6.01, 95% CI = 3.88-9.32) or 11 to 25 medications (OR = 13.80, 95% CI = 8.74-21.80).ConclusionIn 2007, slightly more than half of older adults in hospice who were taking opioids used laxatives during the last week of life. Recent quality indicators from the Centers for Medicare and Medicaid Services recommend laxative treatment when opioid therapy is initiated to prevent opioid-induced constipation and are intended to improve laxative use in individuals in hospice treated with opioids.© 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

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