title: The Burden of Polypharmacy in Patients Near the End of Life.
abstract: BACKGROUND
  Patients with advanced illness are prescribed multiple medications in the last year of life, intensifying the risk of negative consequences related to polypharmacy.
  
  
  OBJECTIVE
  To describe the medication burden of patients near the end of life and identify potential areas for improvement in clinician prescribing practices.
  
  
  METHODS
  This was a prespecified secondary analysis of data from a prospective trial. Eligible participants were adults with less than 12 months estimated prognosis taking a statin medication for primary prevention of cardiovascular disease. Participants were enrolled from 15 sites, randomized to continue or discontinue statin medications, and followed for up to a year. Concomitant medications were recorded at least monthly from study enrollment through death. Prescribed medications were categorized by class and subclass. Descriptive statistics were calculated.
  
  
  RESULTS
  On average, participants (n = 244) were 74.3 years old (SD 11.5) and lived 264 days (SD 128); 47.5% of the patients had a primary diagnosis of malignant tumor. This population was exposed to medications across 51 classes, 192 subclasses, and 423 individual medications. Patients took an average of 11.5 (SD 5) medications at the time of enrollment and 10.7 (SD 5) medications at death or study termination. The five most common classes of medications prescribed near the end of life were antihypertensives, broncholytics/bronchodilators, laxatives, antidepressants, and gastric protection agents.
  
  
  CONCLUSIONS
  There is a significant medication burden placed on patients with advanced illness. Although most medications were prescribed for supportive care, we observed a high prevalence of medications for managing non-life-threatening comorbidities.
authors.affiliation: Center for Learning Health Care, Duke Clinical Research Institute, Durham, North Carolina, USA; Duke University School of Medicine, Durham, North Carolina, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: McNeil
authors.affiliation: Center for Learning Health Care, Duke Clinical Research Institute, Durham, North Carolina, USA; Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina, USA; Division of Medical Oncology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.
authors.forename: Arif H
authors.initials: AH
authors.lastname: Kamal
authors.affiliation: Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA. Electronic address: Jean.Kutner@ucdenver.edu.
authors.forename: Jean S
authors.initials: JS
authors.lastname: Kutner
authors.affiliation: Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, California, USA.
authors.forename: Christine S
authors.initials: CS
authors.lastname: Ritchie
authors.affiliation: Center for Learning Health Care, Duke Clinical Research Institute, Durham, North Carolina, USA; Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina, USA; Division of Medical Oncology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.
authors.forename: Amy P
authors.initials: AP
authors.lastname: Abernethy
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control; D015897:Comorbidity; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D009369:Neoplasms / Q000188:drug therapy / Q000453:epidemiology; D010166:Palliative Care / Q000379:methods* / Q000706:statistics & numerical data*; D019338:Polypharmacy; D011446:Prospective Studies; D013727:Terminal Care / Q000379:methods* / Q000706:statistics & numerical data*
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Palliative care; end of life; polypharmacy