Prescription and Deprescription of Medication During the Last 48 Hours of Life: Multicenter Study in 23 Acute Geriatric Wards in Flanders, Belgium

Noortgate, Nele J. Van Den; Verhofstede, Rebecca; Cohen, Joachim; Piers, Ruth; Deliens, Luc; Smets, Tinne

doi:10.1016/j.jpainsymman.2015.12.325

Cited by 23 publications

(16 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A cross-sectional study of patients in the last few days of life in a geriatric ward in Belgium found that deprescribing of inappropriate medications at the end of life was more frequent if death was expected, and the authors noted further opportunity to optimize medication use by deprescribing drugs at the end of life. They particularly noted that in cases where prognostication is difficult, early discussions of patient's preferences and wishes for end of life care could help to engender trust with the physician and facilitate the process of deprescribing life-long medications at the end of life 27. This is in agreement with a recently published set of recommendations around deprescribing approaches in limited life expectancy that outline the importance of patient-centered, shared decision-making.…”

supporting

confidence: 54%

The Role of Patient Preferences in Deprescribing

Holmes

Todd

2017

Clinics in Geriatric Medicine

View full text Add to dashboard Cite

Polypharmacy and the use of inappropriate medications has become an increasing problem globally. Deprescribing has gained attention as a means to rationalize medication use. Deprescribing interventions have been shown to be generally feasible and safe; in the few studies in which patient preferences are assessed, such interventions also seem to be acceptable to patients. Qualitative studies suggest that patients are interested in reducing medications, may need education about their medications to facilitate deprescribing, and highly value communication with their providers around deprescribing. This article focuses on patient preferences for deprescribing and highlights practical recommendations to overcome barriers to deprescribing.

show abstract

supporting

confidence: 54%

The Role of Patient Preferences in Deprescribing

Holmes

Todd

2017

Clinics in Geriatric Medicine

View full text Add to dashboard Cite

show abstract

“…According to Westbury [33], 'these psychotropic agents should be prescribed cautiously, at the lowest therapeutic doses for as short a time as possible, and be monitored regularly'. The literature consulted shows that identification of the terminal state increases the likelihood of a de-prescription occurring [34]. In the case of nursing homes, this identification is critical for facilitating patients' access to palliative care and, consequently, for improving the quality of care they receive, their satisfaction with it, and their symptoms [35].…”

Section: Discussionmentioning

confidence: 99%

Prospective Evaluation of Intensity of Symptoms, Therapeutic Procedures and Treatment in Palliative Care Patients in Nursing Homes

Puente‐Fernández

Roldán-López

Campos-Calderón³

et al. 2020

JCM

View full text Add to dashboard Cite

The aim of the study is to evaluate the intensity of symptoms, and any treatment and therapeutic procedures received by advanced chronic patients in nursing homes. A multi-centre prospective study was conducted in six nursing homes for five months. A nurse trainer selected palliative care patients from whom the sample was randomly selected for inclusion. The Edmonton Symptoms Assessment Scale, therapeutic procedures, and treatment were evaluated. Parametric and non-parametric tests were used to evaluate month-to-month differences and differences between those who died and those who did not. A total of 107 residents were evaluated. At the end of the follow-up, 39 had (34.6%) died. All symptoms (p < 0.050) increased in intensity in the last week of life. Symptoms were more intense in those who had died at follow-up (p < 0.05). The use of aerosol sprays (p = 0.008), oxygen therapy (p < 0.001), opioids (p < 0.001), antibiotics (p = 0.004), and bronchodilators (p = 0.003) increased in the last week of life. Peripheral venous catheters (p = 0.022), corticoids (p = 0.007), antiemetics (p < 0.001), and antidepressants (p < 0.05) were used more in the patients who died. In conclusion, the use of therapeutic procedures (such as urinary catheters, peripheral venous catheter placement, and enteral feeding) and drugs (such as antibiotics, anxiolytics, and new antidepressant prescriptions) should be carefully considered in this clinical setting.

show abstract

“…An observational study of hospitalized patients at the end of life found higher rates of deprescription than we observed (59.3% for statin deprescription and 62.7% for antihypertensive deprescription). 31 This difference may be accounted for by a variety of factors, such as heightened awareness of deprescription at the end of life, patient inability to tolerate oral medications, and the potential for harm from continuing certain medications in these patients (eg, antihypertensives). A large observational study of treatment deintensification for patients with diabetes in primary care found a deintensification rate of 27%.…”

Section: E4mentioning

confidence: 99%