Use of opioids at the end of life in adults with advanced dementia in Finland

Introduction: Alzheimer's disease as well other types of dementias are inevitably progressive. Recognizing their terminal stage is therefore a basis in the adequate palliative care planning. Pain is believed to be under-treated in elderly, especially in patients with dementia. Method(s): Data from long-term care facilities was extracted from the Resident Assessment Instrument (RAI) database of Finnish National Institute for Health and Welfare during the 3-year study period. Study was descriptive and cross-sectional. Relationships were performed as chi-squares and logistic multivariation tests. Result(s): The total number of assessments was 23454. Mean age was 84 years and it was almost equally distributed across the country. The number of residents over 90 years was significantly higher in Helsinki (27%) compared to the rest of Finland (22%). Two-thirds of residents were female. Opioids were used in more than a third of all observations. Buprenorphine was the most common. Phentanyl (OR 0.35, 95% CI: 0.26-0.47) and buprenorphine (OR 0.73, 95% CI: 0.58-0.90) were significantly less used in Helsinki. Opioids were significantly more used among patients over 90 years (OR 1.30, 95% CI: 1.05-1.62). Despite observed more pain, patients with dementia were more likely to receive lower doses of opioids in Helsinki compared to those in other parts of Finland. However, the lowest percentage of use was found among nursing home residents. Conclusion(s): Our results show that there are clear differences in treatment of patients with dementia at the end of life in Helsinki compared to other parts of Finland, especially among nursing home residents.

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