Discontinuation of Preventive Medicines in Older People with Limited Life Expectancy: A Systematic Review

Drugs & Aging ◽  
2017 ◽  
Vol 34 (10) ◽  
pp. 767-776 ◽  
Author(s):  
Sujita W. Narayan ◽  
Prasad S. Nishtala
2020 ◽  
Vol 58 (9) ◽  
pp. 132-132

AbstractReview of: Shrestha S, Poudel A, Steadman K, et al. Outcomes of deprescribing interventions in older patients with life-limiting illness and limited life expectancy: a systematic review. Br J Clin Pharmacol 2019; doi: 10.1111/bcp.14113 [Epub ahead of print 4 September 2019].


2020 ◽  
pp. 571-578
Author(s):  
Miles Witham ◽  
Jacob George ◽  
Denis O’Mahony

The use of pharmacological agents is often a central component of medical therapy for older people. Medications can relieve symptoms, improve function, and prevent illness, but they also have the capacity to inflict great harm. Older people are at particular risk of such harms as a result of impaired homeostatic reserve, of altered drug metabolism, the presence of multimorbidity and consequent polypharmacy, which increases both exposure to potentially harmful agents and the chance of drug–drug interactions. The therapeutic priorities for older, frail people may differ when compared to younger, robust patients; limited life expectancy means that attempts to prolong life may become relatively less important than the relief of symptoms and avoidance of side effects and medication burden.


2019 ◽  
Vol 85 (5) ◽  
pp. 868-892 ◽  
Author(s):  
Carina Lundby ◽  
Trine Graabæk ◽  
Jesper Ryg ◽  
Jens Søndergaard ◽  
Anton Pottegård ◽  
...  

2019 ◽  
Vol 60 (3) ◽  
pp. 439-449 ◽  
Author(s):  
Carina Lundby ◽  
Trine Graabæk ◽  
Jesper Ryg ◽  
Jens Søndergaard ◽  
Anton Pottegård ◽  
...  

Abstract Background and Objectives Deprescribing may be particularly relevant in older people with limited life expectancy. In order to effectively carry out deprescribing in this population, it is important to understand the perspectives of the full spectrum of health care professionals (HCPs) involved in the management of these patients’ medication. Thus, we aimed to explore different HCPs’ perspectives on deprescribing in older patients with limited life expectancy. Research Design and Methods Six qualitative focus group interviews were conducted using a semistructured approach. The groups comprised HCPs from both primary and secondary care, including family physicians (FPs), geriatricians, clinical pharmacologists, clinical pharmacists, nurses, and health care assistants. Interviews were audio recorded and transcribed verbatim. Results were analyzed using systematic text condensation. Results A total of 32 HCPs participated in the study (median age of 40.5 years; 22% male). The analysis elicited three main themes related to HCPs’ perspectives on deprescribing in older patients with limited life expectancy: (a) Approaching deprescribing, (b) Taking responsibility, and (c) Collaboration across professions. Within themes, subthemes were identified and analyzed. Discussion and Implications Our results imply that different groups of HCPs consider deprescribing an essential aspect of providing good care for older people with limited life expectancy and find that all HCPs play a crucial role in the deprescribing process, with FPs having the primary responsibility. In order to facilitate deprescribing among this population, however, the collaboration between different HCPs should be improved.


Author(s):  
Arjun Poudel ◽  
Shakti Shrestha ◽  
Anna Lukacisinova ◽  
Lisa Nissen

Background: Deprescribing interventions have shown to improve medication appropriateness in older people. However, the evidence on the actual benefits and risks of deprescribing in older adults at the end of life are limited. Due to the lack of evidence on the safety and efficacy of medication in these populations, the most appropriate deprescribing approach is unclear. We aimed to conduct a narrative review of research on existing deprescribing guidelines targeted to frail older people at the end of life. Methods: A literature search was conducted in PubMed, Embase, CINAHL and Google Scholar to identify studies from inception to January 2021 on deprescribing guidelines/tools for frail older adults near end-of-life or palliative situation or life-limiting illnesses or limited life expectancy were included. Results: A total of nine studies were included. The deprescribing guidelines used in these studies were helpful to some extent in optimising medications in patients with limited life expectancy and life-limiting illnesses. Some of them have been tested in prospective studies that showed their usefulness in minimising the number of potentially inapproapriate medications. These studies however were not randomised and involved small sample sizes and had little insight into the clinical outcomes of using these tools. Conclusions: The existing tools and guidelines on deprescribing do not represent the end of life care nor address the medication appropriateness among individuals with a specific condition. An explicit and rigorous consensus-based guideline needs to be developed and tested in a well-designed clinical trial to measure clinically significant outcomes


2018 ◽  
Vol 67 (1) ◽  
pp. 172-180 ◽  
Author(s):  
Wade Thompson ◽  
Carina Lundby ◽  
Trine Graabaek ◽  
Dorthe S. Nielsen ◽  
Jesper Ryg ◽  
...  

Sign in / Sign up

Export Citation Format

Share Document