Deprescribing at the end of life in older patients

Stinson, Matthew J; Gurevitz, Samuel; Carrigan, Anna K.

doi:10.1097/01.jaa.0000558316.40245.ca

Cited by 6 publications

(4 citation statements)

References 31 publications

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“… 4 The goal of deprescribing is to reduce polypharmacy and improve health outcomes, including quality of life measures. 5 , 6 While there are known benefits of deprescribing, many barriers impede this in practice. 7 Deprescribing is a complex and patient-specific process that requires specialized clinicians, communication and collaboration among providers, and a great amount of time dedicated to each patient.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of an Interprofessional Academic-Practice Partnership in End of Life Care

2021

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Introduction: The purpose of this mixed-methods study was to evaluate an interprofessional academic-practice partnership in end of life care by examining patient medication outcomes, the contributions of student pharmacists and a pharmacy preceptor to care teams, and student learning experiences. Methods: Retrospective chart review assessed polypharmacy differences in hospice patients with a primary terminal diagnosis of non-Alzheimer’s dementia between two patient groups; Group 1 managed on interprofessional care teams within the pharmacy partnership, and Group 2, managed on teams without a pharmacist. Team members who interacted with student pharmacists and the pharmacy preceptor participated in semi-structured key informant interviews to document perceptions of pharmacy contributions to care teams and the organization. At the end of their APPE, students completed reflective writings regarding their learning. Results: Patients in Group 1 were on statistically significant fewer medications than Group 2 at both week 4 and weeks 7-12 following admission. Five conceptual themes emerged from interviews: pharmacists as team medication experts, improved patient outcomes, interprofessional collaboration, patient/caregiver trust in medication regimens, and desire for sustainability. Student reflections included the following learning themes: teamwork, respect, value, and patient-centered care. Conclusions: The addition of a pharmacist on interprofessional care teams decreased the average number of medications in the non-Alzheimer’s end of life patient population. Team members identified value-added contributions of student pharmacists and the pharmacy preceptor that enhanced team efficiency and patient care. Student pharmacists recognized these contributions and the experience served as an exemplar of interprofessional practice.

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Section: Introductionmentioning

confidence: 99%

Evaluation of an Interprofessional Academic-Practice Partnership in End of Life Care

2021

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“…Additional research is needed to characterize how providers and older adults value the benefits and potential harms of fracture prevention therapy in the setting of limited life expectancy. Several studies have examined patient and caregiver perceptions regarding use of preventive drug therapy in hospice units and long-term care facilities for patients with life expectancy of 2 years or less, 38,[46][47][48][49][50] but little research has been conducted in community-dwelling older individuals with moderate limits on their life expectancy. Further investigation is also warranted to determine how best to implement discussions of the appropriateness of preventive medication therapies for these individuals in the clinical practice setting that accurately captures their values and preferences.…”

Section: Discussionmentioning

confidence: 99%

Balancing fracture risk versus risk of mortality before fracture among women aged 80 years or older

Schousboe,

Langsetmo,

Fink

et al. 2024

J American Geriatrics Society

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BackgroundMost fractures occur in women aged ≥80 years but competing mortality unrelated to fracture may limit the benefit of osteoporosis drug therapy for some women in late life. Our primary aim was to develop separate prediction models for non‐spine fracture (NSF) and mortality before fracture to identify subsets of women with varying fracture versus mortality risks.MethodsSeparate prediction models were developed for NSF and mortality before NSF for 4895 women aged ≥80 years enrolled in the Study of Osteoporotic Fractures (SOF) or the Health Aging and Body Composition (HABC) study. Proportional hazards models modified to account for competing mortality were used to identify candidate risk factors for each outcome. Predictors associated with NSF or mortality (p < 0.2) were included in separate competing risk models to estimate the cumulative incidence of NSF and mortality before NSF during 5 years of follow‐up. This process was repeated to develop separate prediction models for hip fracture and mortality before hip fracture.ResultsSignificant predictors of NSF (race, total hip BMD, grip strength, prior fracture, falls, and use of selective serotonin reuptake inhibitors, benzodiazepines, or oral/transdermal estrogen) differed from predictors of mortality before NSF (age, walking speed, multimorbidity, weight change, shrinking, smoking, self‐rated health, dementia, and use of warfarin). Within nine subsets of women defined by tertiles of risk, 5‐year outcomes varied from 28% NSF and 8% mortality in the high‐risk NSF/low‐risk mortality subset, to 9% NSF and 22% mortality in the low‐risk NSF/high‐risk mortality subset. Similar results were seen for predictors of hip fracture and mortality before hip fracture.ConclusionConsiderable variation in 5‐year competing mortality risk is present among women in late life with similar 5‐year NSF risk. Both fracture risk and life expectancy should inform shared clinical decision‐making regarding initiation or continuation of osteoporosis drug therapy for women aged ≥80 years.

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“…• Adopting a proactive approach, including systematic and regular assessment of symptom severity and response to treatment, using validated and reliable tools; (52,53) and considering pre-printed orders (PPO) such as for managing EOL symptoms (54,55) and the dying protocol. (56) • Providing access to palliative and geriatrics experts, not only to help build capacity but also to help manage complex and intractable symptoms.…”

Section: End-of-life Symptoms Should Be Managed Effectivelymentioning

confidence: 99%

Improving End-of-Life Care for People with Dementia in LTC Homes During the COVID-19 Pandemic and Beyond

et al. 2021

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COVID-19 pandemic has resulted in a significant increase in deaths in long-term care homes (LTCH). People with dementia living in LTCHs represent one of the most frail and marginalized populations in Canada. The surge of COVID-19 cases in LTCHs and rationing of health-care resources during the pandemic have amplified the pre-existing need for improvements in palliative and end-of-life care in LTCHs. This position statement, created by a task force commissioned by the Alzheimer Society of Canada, provides recommendations for a multipronged coordinated approach to improving palliative and end-of-life care of people with dementia living in LTCHs during the COVID-19 pandemic and beyond.

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Deprescribing at the end of life in older patients

Cited by 6 publications

References 31 publications

Evaluation of an Interprofessional Academic-Practice Partnership in End of Life Care

Evaluation of an Interprofessional Academic-Practice Partnership in End of Life Care

Balancing fracture risk versus risk of mortality before fracture among women aged 80 years or older

Improving End-of-Life Care for People with Dementia in LTC Homes During the COVID-19 Pandemic and Beyond

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