Pharmacological management of co-morbid conditions at the end of life: is less more?

McLean, Sarah; Sheehy-Skeffington, Barbara; O’Leary, Norma; O’Gorman, Aisling

doi:10.1007/s11845-012-0841-6

Cited by 39 publications

(37 citation statements)

References 15 publications

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“…When the patient was resident in hospital (compared with at home or in a nursing home), it was less likely that an antibiotic would be prescribed and more likely that simvastatin and quetiapine would be discontinued. Patient place of residence has been shown to impact on prescribing in a recent study of a specialist palliative care service in Ireland in which patients in community settings (comprising home and nursing home care) were prescribed more medications for co-morbid conditions towards the end of life than patients in the hospital setting (McLean et al, 2013).…”

Section: Discussionmentioning

confidence: 99%

Assessment of factors that influence physician decision making regarding medication use in patients with dementia at the end of life

Parsons

McCorry

Murphy

et al. 2013

Int J Geriat Psychiatry

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Section: Discussionmentioning

confidence: 99%

Assessment of factors that influence physician decision making regarding medication use in patients with dementia at the end of life

Parsons

McCorry

Murphy

et al. 2013

Int J Geriat Psychiatry

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“…5,6 Polypharmacy is particularly burdensome near the end of life, as patients Baccumulatem edications to a treat life-limiting illness and its associated symptoms, prevent age-related diseases, and control non-lifethreatening comorbidities. 7 In an analysis of medication burden among a cohort of adults with advanced, life-limiting illness, participants took an average of 11.5 (standard deviation (SD) 5) medications, and the most commonly used medications were for primary disease prevention (e.g., anti-hypertensives), not symptom management. 8 Patients near the end of life may be receiving medications whose risk is higher than the benefit.…”

Section: Introductionmentioning

confidence: 99%

Associations Between Polypharmacy, Symptom Burden, and Quality of Life in Patients with Advanced, Life-Limiting Illness

et al. 2019

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BACKGROUND: Polypharmacy may be particularly burdensome near the end of life, as patients Baccumulatem edications to treat and prevent multiple diseases. OBJECTIVE: To evaluate associations between polypharmacy, symptom burden, and quality of life (QOL) in patients with advanced, life-limiting illness (clinician-estimated, 1 month-1 year). DESIGN: Secondary analysis of baseline data from a trial of statin discontinuation. PARTICIPANTS: Adults with advanced, life-limiting illness. MAIN MEASURES: Polypharmacy was assessed by summing the number of non-statin medications taken regularly or as needed. Symptom burden was assessed using the Edmonton Symptom Assessment Scale (range 0-90; higher scores indicating greater symptom burden) and QOL was assessed using the McGill QOL Questionnaire (range 0-10; higher scores indicating better QOL). Linear regression models assessed associations between polypharmacy, symptom burden, and QOL. KEY RESULTS: Among 372 participants, 47% were age 75 or older and 35% were enrolled in hospice. The mean symptom score was 27.0 (standard deviation (SD) 16.1) and the mean QOL score was 7.0 (SD 1.3). The average number of non-statin medications was 11.6 (SD 5.0); onethird of participants took ≥ 14 medications. In adjusted models, higher polypharmacy was associated with higher symptom burden (coefficient 0.81; p < .001) and lower QOL (coefficient − .06; p = .001). Adjusting for symptom burden weakened the association between polypharmacy and QOL (coefficient − .03; p = .045) without a significant interaction, suggesting that worse quality of life associated with polypharmacy may be related to medicationassociated symptoms. CONCLUSIONS: Among adults with advanced illness, taking more medications is associated with higher symptom burden and lower QOL. Attention to medicationrelated symptoms and shared decision-making regarding deprescribing are warranted in this setting. NIH TRIAL REGISTRY NUMBER: ClinicalTrials.gov Identifier for Parent Study -NCT01415934 KEY WORDS: pharmaceutical care; quality of life; end-of-life care; geriatrics.

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“…However, some medications considered to be inappropriate in the general older population may be used appropriately—eg for symptom relief—in a palliative care setting. Thus, these criteria require adaptation in order to be applicable in palliative care …”

Section: Introductionmentioning

confidence: 99%

Discontinuation of medications at the end of life: A population study in Belgium, based on linked administrative databases

Paque

Schreye

Elseviers

et al. 2019

Brit J Clinical Pharma

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Aims: The aim of this study was to examine the use of potentially inappropriate medication (PIM) in relation to time before death, to explore whether PIMs are discontinued at the end of life, and the factors associated with this discontinuation. Methods:We conducted a retrospective register-based mortality cohort study of all deceased in 2012 in Belgium, aged at least 75 years at time of death (n = 74 368), using linked administrative databases. We used STOPPFrail to identify PIMs received during the period from 12 to 6 months before death (P1) and the last 4 months (P2) of life.Results: Median age was 86 (IQR 81-90) at time of death, 57% were female, 38%were living in a nursing home, and 16% were admitted to hospital between 2 years and 4 months before death. Overall, PIM use was high, and increased towards death for all PIMs. At least one PIM was discontinued during P2 for one in five (20%) of the population, and 49% had no discontinuation. Being hospitalized in the period before the last 4 months of life, living in a nursing home, female gender and a higher number of medications used during P1 were associated with discontinuation of PIMs (respective aOR [95% CI]: 2.89 [2.73-3.06], 1.29 [1.23-1.36], 1.26 [1.20-1.32], 1.17 [1.16-1.17]). Conclusion: Initial PIM use was high and increased towards death. Discontinuation was observed in only one in five PIM users. More guidance for discontinuation of PIMs is needed: practical, evidence-based deprescribing guidelines and implementation plans, training for prescribers and a better consensus on what inappropriate medication is.

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Pharmacological management of co-morbid conditions at the end of life: is less more?

Cited by 39 publications

References 15 publications

Assessment of factors that influence physician decision making regarding medication use in patients with dementia at the end of life

Assessment of factors that influence physician decision making regarding medication use in patients with dementia at the end of life

Associations Between Polypharmacy, Symptom Burden, and Quality of Life in Patients with Advanced, Life-Limiting Illness

Discontinuation of medications at the end of life: A population study in Belgium, based on linked administrative databases

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