Withholding, discontinuing and withdrawing medications in dementia patients at the end of life: a neglected problem in the disadvantaged dying?
Recent years have seen a growing recognition that dementia is a terminal illness and that patients with advanced dementia nearing the end of life do not currently receive adequate palliative care. However, research into palliative care for these patients has thus far been limited. Furthermore, there has been little discussion in the literature regarding medication use in patients with advanced dementia who are nearing the end of life, and discontinuation of medication has not been well studied despite its potential to reduce the burden on the patient and to improve quality of life. There is limited, and sometimes contradictory, evidence available in the literature to guide evidence-based discontinuation of drugs such as acetylcholinesterase inhibitors, antipsychotic agents, HMG-CoA reductase inhibitors (statins), antibacterials, antihypertensives, antihyperglycaemic drugs and anticoagulants. Furthermore, end-of-life care of patients with advanced dementia may be complicated by difficulties in accurately estimating life expectancy, ethical considerations regarding withholding or withdrawing treatment, and the wishes of the patient and/or their family. Significant research must be undertaken in the area of medication discontinuation in patients with advanced dementia nearing the end of life to determine how physicians currently decide whether medications should be discontinued, and also to develop the evidence base and provide guidance on systematic medication discontinuation.
Parsons
Carole
C
Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, Northern Ireland. c.parsons@qub.ac.uk
Hughes
Carmel M
CM
Passmore
A Peter
AP
Lapane
Kate L
KL
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000924:Anticholesteremic Agents / Q000627:therapeutic use; D000978:Antiparkinson Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use; D003704:Dementia / Q000188:drug therapy*; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D010166:Palliative Care; D019338:Polypharmacy; D013727:Terminal Care / Q000941:ethics*; D014149:Tranquilizing Agents / Q000627:therapeutic use; D035862:Vulnerable Populations; D028761:Withholding Treatment / Q000941:ethics*
D000900:Anti-Bacterial Agents; D000924:Anticholesteremic Agents; D000978:Antiparkinson Agents; D014150:Antipsychotic Agents; D002800:Cholinesterase Inhibitors; D004791:Enzyme Inhibitors; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D014149:Tranquilizing Agents