Prescribing in Palliative Care as Death Approaches

Currow, David C.; Stevenson, James P.; Abernethy, Amy P.; Plummer, John L.; Shelby‐James, Tania

doi:10.1111/j.1532-5415.2007.01124.x

Cited by 190 publications

(209 citation statements)

References 28 publications

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“…The post-death data collection indicated that there was a decrease in the proportion of never appropriate medications and an increase in the proportion of always appropriate medications for those residents who died during the study period. This is noteworthy despite the small number of residents involved; it may suggest a move away from curative goals of therapy towards palliative management of symptoms, as has been observed in other studies [3,20,21,45].…”

Section: Discussionsupporting

confidence: 51%

Development and Application of Medication Appropriateness Indicators for Persons with Advanced Dementia: A Feasibility Study

et al. 2014

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USA) for their advice regarding study design. The authors would also like to thank the physicians who participated in the Delphi consensus panel survey, and the residents, their relatives and care home staff who participated in the feasibility study. AbstractBackground: No studies have been conducted in the United Kingdom (UK) context to date which categorise medications in terms of appropriateness for patients with advanced dementia, or which examine medication use in these vulnerable patients.Objectives: To categorise the appropriateness of a comprehensive list of medications and medication classes for use in patients with advanced dementia; to examine the feasibility of conducting a longitudinal prospective cohort study to collect clinical and medication use data;and to determine the appropriateness of prescribing for nursing home residents with advanced dementia in Northern Ireland (NI), using the categories developed.Methods: Three-round Delphi consensus panel survey of expert clinicians, to categorise the appropriateness of medications for patients with advanced dementia (defined as having Functional Assessment Staging [FAST] scores ranging from 6E to 7F). This was followed by a longitudinal prospective cohort feasibility study which was conducted in three nursing homes in NI. Clinical and medication use for participating residents with advanced dementia (FAST scores ranging from 6E to 7F) were collected and a short test of dementia severity administered.These data were collected at baseline and every three months for up to nine months or until death. For those residents who died during the study period, data were also collected within 14 days of death. The appropriateness ratings from the consensus panel survey were retrospectively applied to residents' medication data at each data collection timepoint to determine the appropriateness of medications prescribed for these residents.Results: Consensus was achieved for 87 (90%) of the 97 medications and medication classes included in the survey. Fifteen residents were recruited to participate in the longitudinal prospective cohort feasibility study, four of whom died during the data collection period. Mean numbers of medications prescribed per resident were 16.2 at baseline, 19.6 at three months, 17.4 at six months and 16.1 at nine months respectively. Fourteen residents at baseline were taking at least one medication considered by the consensus panel to be never appropriate, and approximately 25% of medications prescribed were considered to be never appropriate. Postdeath data collection indicated a decrease in the proportion of never appropriate medications and an increase in the proportion of always appropriate medications for those residents who died. Conclusions

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Section: Discussionsupporting

confidence: 51%

Development and Application of Medication Appropriateness Indicators for Persons with Advanced Dementia: A Feasibility Study

et al. 2014

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“…(6) Our findings are also consistent with a study by Currow et al that found consultative community and hospital based palliative care services reduced the number of medications for comorbid medical conditions by 1.1 per patient. (9) Finally, Garfinkel et al examined the impact of a consult service that used a geriatric-palliative care approach to improve drug use in older hospitalized patients. They found that they were able to discontinue one or more medications that lacked a valid or relevant indication, given the patient's age group and disability level, in 63% of 190 patients.…”

Section: Discussionmentioning

confidence: 99%

“…(5) Previous successful strategies for reducing polypharmacy and/or unnecessary medication use in the elderly include an acute care geriatric evaluation and management team, (6) an interdisciplinary team in nursing home care, (7) a geriatric-palliative care algorithm, (8) and a consultative community and hospital based palliative care service. (9) In the one study in nursing homes, interdisciplinary team care resulted in the reduction of unnecessary medications per patient from 1.57 at admission to 0.34 at closeout. (7) The nation's largest integrated health care system, the Veterans Affairs (VA) Healthcare System, is intensely interested in optimizing care at the end of life and has greatly expanded its hospice and palliative care services, including those for older adults residing in nursing homes.…”

Section: Introductionmentioning

confidence: 99%

Impact of a Geriatric Nursing Home Palliative Care Service on Unnecessary Medication Prescribing (766)

2009

Journal of Pain and Symptom Management

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“…One study, mostly in older patients with cancer, examined drugs prescribed at initial referral to a palliative service and monthly until death. 8 As death approached, the total number of drugs increased, with a decrease in drugs for comorbid conditions and an increase in drugs used to control symptoms. Many of the drugs used to control symptoms are classed as 'high risk' in older patients.…”

Section: Terminal Conditionsmentioning

confidence: 99%

Deprescribing in the Last Year of Life

Hardy

Hilmer

2011

Pharmacy Practice and Res

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Polypharmacy and adverse drug reactions are common with ageing. Deprescribing or ceasing unnecessary or harmful medications is an important component of aged care practice, especially in the final year of life. Changes in pharmacokinetics and pharmacodynamics with ageing can affect decisions about deprescribing. Similarly, the balance between risk and benefit for medications is often altered in patients in their final year of life and needs to be taken into account. There is evidence for medicines that can be safely ceased abruptly and medicines that need to be weaned. An individualised approach is required to assess prognosis, trajectory of decline and therapeutic goals for each patient. An algorithm is provided in this review to guide safe, rational deprescribing for patients who are believed to be in their last year of life.

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Prescribing in Palliative Care as Death Approaches

Abstract: Prescribing changes as life-limiting illnesses progress, with older people taking more medications. Medications for comorbid medical conditions should be reviewed in the context of their original therapeutic goals.

Cited by 190 publications

References 28 publications

Development and Application of Medication Appropriateness Indicators for Persons with Advanced Dementia: A Feasibility Study

Development and Application of Medication Appropriateness Indicators for Persons with Advanced Dementia: A Feasibility Study

Impact of a Geriatric Nursing Home Palliative Care Service on Unnecessary Medication Prescribing (766)

Deprescribing in the Last Year of Life

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