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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

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Key Summary Points

AbstractSection 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.

AbstractSection 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.

AbstractSection 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.

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Funding

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

Author information

Authors and Affiliations

  1. Department of Pharmacology, Toxicology and Pharmacovigilance, University Hospital of Limoges, 2 avenue Martin Luther King, 87042, Limoges Cedex, France

    Barbara Roux & Marie-Laure Laroche

  2. INSERM UMR 1248, University of Limoges, Limoges, France

    Barbara Roux & Marie-Laure Laroche

  3. Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden

    Lucas Morin

  4. Department of Geriatric Medicine, University Hospital of Limoges, Limoges, France

    Arnaud Papon

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  1. Barbara Roux
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  2. Lucas Morin
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Correspondence to Barbara Roux.

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Roux, B., Morin, L., Papon, A. et al. Prescription and deprescription of medications for older adults receiving palliative care during the last 3 months of life: a single-center retrospective cohort study. Eur Geriatr Med 10, 463–471 (2019). https://doi.org/10.1007/s41999-019-00175-3

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