Polypharmacy Common in Patients Nearing the End of Life

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Clinical guidelines needed to help with decisions regarding use of medications near the end of life
Clinical guidelines needed to help with decisions regarding use of medications near the end of life

(HealthDay News) — Patients with life-limiting illness often receive medications of questionable benefit given their remaining life span, according to a report published online May 15 in The American Journal of Medicine.

The study included 511,843 adults, aged 65 and older, in Sweden. All died between 2007 and 2013. The proportion of patients on at least 10 different medications rose from 30.3 to 47.2 percent during the year before death, the findings showed.

Many patients were given a high number of drugs near the end of life to control symptoms. But for some, long-term preventive medications or disease-specific drugs were also continued until the end of life, the researchers found. For example, during the last month of life, almost half of patients (53.8 percent) used antithrombotic agents. In addition, 41.1 percent were taking β-blockers and 15.4 percent were taking a calcium channel blocker. Angiotensin-converting enzyme inhibitors were taken by 21.4 percent, vasodilators by 17.4 percent, potassium-sparing medications by 12.1 percent, and 15.8 percent of people in the study were taking statins.

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"Physicians should consider discontinuing drugs that may be effective and otherwise appropriate but whose potential harms outweigh the benefits that patients can reasonably expect before death occurs. The process of deprescribing requires timely patient-family-physician dialogue about the risk/benefit ratio of medications, and close monitoring of symptoms," the authors write. "It is also essential that patients and their relatives receive clear information about their options in terms of palliative care, to counter the feeling of abandonment that they may experience when disease-directed treatments are withdrawn."

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