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Prescription and deprescription of medications for older adults receiving palliative care during the last 3 months of life: a single-center retrospective cohort study

  • Barbara RouxEmail author
  • Lucas Morin
  • Arnaud Papon
  • Marie-Laure Laroche
Research Paper

Key Summary Points

Aim

To assess the evolution and quality of drug therapy throughout the last 3 months of life of older adults in need of palliative care.

Findings

This study highlights the preferential prescription of essential drugs and deprescription of unnecessary drugs during the last 3 months of life in older adults. However, palliative care occurs principally during the last week of life and a high burden of unnecessary drugs is still found on the day of death.

Message

Both earlier implementation of palliative care and an improvement of prescribing practices are needed by setting up interventions to raise awareness and promote early physician–patient communication about care goals and potential benefits of deprescribing unnecessary drugs.

Abstract

Purpose

Near the end of life, drugs to ensure comfort and improve quality of life should be prioritized, and unnecessary drugs should be avoided. The aim was to assess the evolution and quality of drug therapy throughout the last 3 months of life of older adults in need of palliative care.

Methods

A single-center retrospective cohort study included older adults (≥ 65 years) who died in a teaching hospital between 1 January 2014 and 30 June 2014 and had been identified as patients in need of palliative care in their last 3 months of life. Drugs were collected from electronic medical records and defined as ‘unnecessary’ or ‘essential’ based on a review of the literature.

Results

A total of 149 patients were included [age: 82.1 (SD 8.6) years, women: 46.3%]. The mean number of medications varied from 6.7 (SD 3.3) drugs 90 days before death, to 7.5 (SD 4.1) 7 days before death, to 5.6 (SD 3.6) on the day of death. During the final week of life, one additional prescription of essential drugs was observed for 75.2% of patients and 79.3% of patients had at least one unnecessary drug deprescribed. The most prescribed and deprescribed drug classes were, respectively, analgesics (56.4%) and antithrombotic agents (38.2%) during the last week of life.

Conclusions

Near the end of life, medication therapy is adapted to the goals of palliative care. However, this only occurs during the last week of life. Earlier transition to palliative care is necessary to avoid exposure to unnecessary drugs.

Keywords

End-of-life care Palliative care Older adults Medication therapy management 

Notes

Funding

The authors(s) received no financial support for the research, authorship and/or publication of this article.

Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study, formal consent was not required.

Supplementary material

41999_2019_175_MOESM1_ESM.pdf (202 kb)
Supplementary file1 (PDF 201 kb)

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Copyright information

© European Geriatric Medicine Society 2019

Authors and Affiliations

  1. 1.Department of Pharmacology, Toxicology and PharmacovigilanceUniversity Hospital of LimogesLimoges CedexFrance
  2. 2.INSERM UMR 1248University of LimogesLimogesFrance
  3. 3.Aging Research CenterKarolinska Institutet and Stockholm UniversityStockholmSweden
  4. 4.Department of Geriatric MedicineUniversity Hospital of LimogesLimogesFrance

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