End-of-Life Care Varies

Summary

This study reveals significant differences in end-of-life care practices between Alberta and Ontario. Researchers found substantially lower rates of injectable medication prescriptions for end-of-life symptom relief in Alberta long-term care facilities compared to Ontario. The study highlights the need for further investigation into these variations and the potential impact on quality of care.

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** Main Story**

So, I was reading this interesting study the other day, published in the Canadian Geriatrics Journal (March 6th, 2025, if you’re curious). It looked at how end-of-life medications are prescribed in long-term care (LTC) facilities in Alberta versus Ontario. What they found was pretty striking: there’s a significant difference in prescribing rates, specifically when it comes to injectable medications used for symptom relief in the last two weeks of life.

Basically, Alberta’s prescribing rates are noticeably lower than Ontario’s. It really got me thinking about the implications for geriatric care and whether everyone is getting the care they need, right?

Disparities in Prescribing Rates

The study was a retrospective cohort analysis, digging into administrative data from LTC residents who passed away between January 1, 2017, and March 17, 2020. The Alberta data was then compared to a previously published study on Ontario. They looked at over 10,000 deceased residents across 117 Alberta LTC homes. And here’s the kicker: only 16.9% of Alberta residents received injectable end-of-life medications, compare that to a whopping 64.7% in Ontario!

It’s a huge difference! This difference persisted, even when you looked at all routes of medication administration. In Alberta only 44.9% of residents received any end-of-life medication in those crucial final two weeks, compared to, again, a much larger number in Ontario. It really begs the question, what’s going on here?

Medication Usage Breakdown

Now, let’s talk specifics. Injectable opioids, especially hydromorphone, were the most commonly prescribed medications in both provinces. But, surprise, surprise, the usage rates were drastically different. In Alberta, only 8% of decedents received injectable opioids (and just 4.8% got hydromorphone). Ontario, on the other hand, was way higher, with 62.7% receiving injectable opioids and 52.1% receiving hydromorphone.

Plus, further analysis showed significant differences in prescribing rates for other injectable meds like benzodiazepines and antipsychotics. These are used to manage end-of-life symptoms like pain, anxiety, and delirium. The researchers even broke down the LTC homes into five groups, based on their prescribing rates. The lowest group in Alberta only had a rate of 0.5%, while the highest reached 45.6%. Ontario also had variability between facilities, but even their lowest prescribing rate (37.6%) was close to Alberta’s highest. I mean, think about that for a second; it’s wild, right?

Quality of Care Considerations

Okay, so before we jump to conclusions, the study authors make a good point. They caution against using prescribing rates as the only measure of care quality. There are data limitations, and we need more qualitative research to really understand why these differences exist. For example, there was no connection between prescribing levels and the rate of residents being transferred out of LTC in their last two weeks. So, it wasn’t simply a matter of residents needing more acute care elsewhere.

That said, the study absolutely highlights the need to investigate potential barriers to getting proper end-of-life care in Alberta’s LTC facilities. Could it be differences in physician prescribing habits? Or maybe differing patient preferences? Or maybe even limited access to palliative care services in general? Perhaps it is a combination of these factors?

Looking Ahead

Ultimately, this study sparks some important questions about equal access to end-of-life care. In the future, we need more research to dig into the reasons behind these variations. I’d love to see studies that explore the experiences of residents and their families, and the impact these prescribing practices have on symptom management and quality of life as the end approaches. I think understanding the diverse needs and preferences of residents is crucial for person-centered end-of-life care.

After all, we want to ensure comfort, dignity, and respect for everyone, don’t we? To achieve that, a comprehensive evaluation of end-of-life care is critical, one that goes beyond simple metrics and factors in a deeper understanding of the complex influences at play.