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

• DOI: 10.1007/s11845-012-0841-6
• Publication Date: 2012-07-28T13:27:25Z
• Authors: S. McLean; B. Sheehy-Skeffin...; N. O’Leary; A. O’Gorman
• Keywords: Male; Peripheral Vascular Diseases; Terminal Care; Inappropriate Prescribing; Comorbidity; Middle Aged; 3. Good health; Stroke; Pulmonary Disease, Chronic Obstructive; 03 medical and health sciences; 0302 clinical medicine; Alzheimer Disease; Neoplasms; Polypharmacy; Humans; Kidney Failure, Chronic; Female; Aged

Co-morbid conditions (CMCs) are present in over half of patients with cancer over 50 years of age. As life-limiting illnesses progress, the benefits and burdens of treatments for CMCs become unclear. Relevant issues include physiological changes in advanced illness, time-to-benefit of medications, burden of medications, and psychological impact of discontinuing medications. Optimal prescribing is unclear due to lack of evidence.The objectives are to determine prescribing practice, for CMCs, in a single SPC service.Patients referred to a single specialist palliative care (SPC) service, who died between 1/8/2010 and 30/9/2012, were identified. Medical notes were reviewed, and data collected on prescribing at 3 months, 1 month, and 1 week prior to death.Fifty-two patients with a median age of 74.5 years were identified; 41 patients (79%) had a malignant condition. 50% died in hospital. Patients had a mean of three CMCs. A mean of 4.6 medications for CMCs were prescribed to patients over 65. A mean of 10 medications in total were prescribed at 1 week before death. One week before death, one-third of patients continued to be prescribed aspirin, and over one-quarter a statin.Total medication burden increases as time to death shortens, due to continuation of medications for CMCs, and addition of medications for symptom control. There is a need for research to demonstrate the impact of polypharmacy at the end of life, in order to formulate a framework to guide practice.