학술논문
Comorbidities, symptoms and end-of-life medication use in hospitalised decedents before and during the COVID-19 pandemic: a retrospective regional cohort study in Ottawa, Canada
Document Type
article
Author
Shirley H Bush; Monisha Kabir; Peter Lawlor; James Downar; Brandi Vanderspank-Wright; Sarina Isenberg; Peter Tanuseputro; Akshai Iyengar; Claire Dyason; Julie Lapenskie; Colleen Webber; Henrique Parsons; Samantha Rose Adeli; Ella Besserer; Leila Cohen; Valérie Gratton; Rebekah Murphy; Grace Warmels; Adrianna Bruni; Chelsea Noel; Brandon Heidinger; Koby Anderson; Kyle Arsenault-Mehta; Krista Wooller; Daniel Bedard; Paula Enright; Isabelle Desjardins; Khadija Bhimji
Source
BMJ Open, Vol 13, Iss 9 (2023)
Subject
Language
English
ISSN
2044-6055
Abstract
Objective To compare comorbidities, symptoms and end-of-life (EoL) palliative medication (antisecretories, opioids, antipsychotics and sedatives) use among decedents before and during the COVID-19 pandemic.Design In a retrospective cohort study, decedent records in three acute care hospitals were abstracted, generating a prepandemic (November 2019–February 2020) group (pre-COVID) and two intrapandemic (March–August 2020, wave 1) groups, one without (COVID-ve) and one with COVID-19 infection (COVID+ve). Control group decedents were matched 2:1 on age, sex and care service (medicine/intensive care unit (ICU)) with COVID+ve decedents.Setting Three regional acute care teaching hospitals in Ottawa, CanadaParticipants Decedents (N=425): COVID+ve (n=85), COVID-ve (n=170) and pre-COVID (n=170).Main outcome measures Data were abstracted regarding demographics, admission comorbidities and symptoms, and EoL medication use; opioid doses were standardised to parenteral morphine equivalent daily dose (MEDD), and the predictors of upper quartile MEDD in the last 24 hours of life were examined in multivariable logistic regression with adjusted ORs (aORs) and 95% CIs.Results The prevalence of dementia (41% vs 28% and 26%, p=0.03), breathlessness (63.5% vs 42% and 47%, p