Individualising Life Expectancy Is Necessary for Optimal Prescribing

Abstract

One possible cause of overprescribing (or insufficient deprescribing) is the failure to explicitly address the individual’s life expectancy (LE). For example, if a LE estimate shows the person has six months to live, this should influence the prescribing of a medication that offers benefits only over a much longer LE. Predicting exactly the number of years a person will live is impossible, but probabilistic forecasting is possible and arguably essential, both for the selection of the optimal intervention and for meeting the ‘reasonable patient’ standard of information about the harms and benefits of alternative options. One side-effect of the COVID-19 pandemic has been to bring mortality into greater prominence, hopefully facilitating its discussion in the clinic as part of the ‘new normal’. This paper outlines the case for introducing LE into prescribing decisions as a way of making more individualised decisions and potentially reducing overprescribing. It concentrates on how the clinical task of arriving at individualised estimates of LE might be tackled, especially in the case of the growing number of older patients with heterogeneous sociodemographic characteristics who are experiencing multiple long term conditions of varying severity and are frequently subject to ‘polypharmacy’.