title: Pharmacological management of co-morbid conditions at the end of life: is less more?
abstract: BACKGROUND
  Co-morbid conditions (CMCs) are present in over half of patients with cancer over 50 years of age. As life-limiting illnesses progress, the benefits and burdens of treatments for CMCs become unclear. Relevant issues include physiological changes in advanced illness, time-to-benefit of medications, burden of medications, and psychological impact of discontinuing medications. Optimal prescribing is unclear due to lack of evidence.
  
  
  OBJECTIVE
  The objectives are to determine prescribing practice, for CMCs, in a single SPC service.
  
  
  METHODS
  Patients referred to a single specialist palliative care (SPC) service, who died between 1/8/2010 and 30/9/2012, were identified. Medical notes were reviewed, and data collected on prescribing at 3 months, 1 month, and 1 week prior to death.
  
  
  RESULTS
  Fifty-two patients with a median age of 74.5 years were identified; 41 patients (79%) had a malignant condition. 50% died in hospital. Patients had a mean of three CMCs. A mean of 4.6 medications for CMCs were prescribed to patients over 65. A mean of 10 medications in total were prescribed at 1 week before death. One week before death, one-third of patients continued to be prescribed aspirin, and over one-quarter a statin.
  
  
  CONCLUSIONS
  Total medication burden increases as time to death shortens, due to continuation of medications for CMCs, and addition of medications for symptom control. There is a need for research to demonstrate the impact of polypharmacy at the end of life, in order to formulate a framework to guide practice.
authors: Specialist Palliative Care Service, Dochas Centre, Our Lady of Lourdes Hospital, Drogheda, Co. Louth, Ireland. smclean81@yahoo.com
authors: S
authors: S
authors: McLean
authors: B
authors: B
authors: Sheehy-Skeffington
authors: N
authors: N
authors: O'Leary
authors: A
authors: A
authors: O'Gorman
mesh_terms: D000368:Aged; D000544:Alzheimer Disease / Q000188:drug therapy / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D006801:Humans; D057970:Inappropriate Prescribing; D007676:Kidney Failure, Chronic / Q000188:drug therapy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy* / Q000453:epidemiology; D016491:Peripheral Vascular Diseases / Q000188:drug therapy / Q000453:epidemiology; D019338:Polypharmacy; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000453:epidemiology; D020521:Stroke / Q000188:drug therapy* / Q000453:epidemiology; D013727:Terminal Care