Polypharmacy in palliative care—COPD and multimorbidity

A case report
main topic
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Summary

This is the case report of an 80-year-old woman with advanced chronic obstructive pulmonary disease (COPD), multimorbidity and frailty. Despite regular critical re-evaluation of on-going medication, a significant reduction of prescribed medication was not achieved up until the patient’s terminal phase, and this may have contributed to several episodes of delirium. It was particularly difficult to reduce the number of prescribed drugs due to cardiovascular, endocrinologic, orthopaedic, neurologic, psychiatric and pulmonary comorbidities. Probable drug–drug interactions and side effects were repeatedly observed. This case report aims to describe a dilemma frequently encountered in the care of patients with progressed pulmonary disease in the context of frailty and multimorbidity.

Keywords

Chronic Obstructive Pulmonary Disease Polypharmacy Palliative care Delirium Multimorbidity Interactions 

Polypharmazie in der Palliativmedizin – COPD und Multimorbidität

Fallbericht

Zusammenfassung

Dargestellt wird der Fall einer 80-jährigen Frau mit weit fortgeschrittener chronisch obstruktiver Lungenerkrankung (COPD), Multimorbidität und Gebrechlichkeit. Trotz regelmäßiger kritischer Reevaluierung der laufenden Medikation wurde eine relevante Reduktion der verordneten Medikamente bis kurz vor dem Tod der Patientin nicht erreicht, und dies trug wahrscheinlich zu wiederholten Episoden eines Delirs bei. Aufgrund von endokrinologisch, kardiovaskulär, orthopädisch, neurologisch, psychiatrisch und pulmonal bedingter Multimorbidität war es besonders schwierig, die Anzahl der Medikamente zu reduzieren. Mögliche Interaktionen und Nebenwirkungen wurden wiederholt beobachtet. In der vorliegenden Falldarstellung zeigt sich ein Dilemma, dass sich in der Betreuung von Patienten mit weit fortgeschrittener Lungenerkrankung und begleitender Multimorbidität und Gebrechlichkeit häufig stellt.

Schüsselwörter

Chronisch obstruktive Lungenerkrankung Polypharmazie Palliativmedizin Delir Multimorbidität Interaktionen 

Notes

Acknowledgements

Special thanks are owed to Annette Henry MD and Dietmar Weixler MD for continued support and mentoring in Palliative Care. I also wish to thank my interdisciplinary team at Franziskus Spital Vienna for their involved work and readiness to engage in discussion and decision-making.

Conflict of interest

M. Rowhani and B. Iglseder declare that they have no competing interests.

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Copyright information

© Springer-Verlag GmbH Austria, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Franziskus SpitalViennaAustria
  2. 2.Department of Geriatric MedicineSalzburger Landeskliniken Betriebs-GesmbH, Christian-Doppler-Klinik, Paracelsus Medical University Salzburg AustriaSalzburgAustria

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