title: Prescription and Deprescription of Medication During the Last 48 Hours of Life: Multicenter Study in 23 Acute Geriatric Wards in Flanders, Belgium.
abstract: Palliative care for the older person is often limited, resulting in poor quality of dying. Pharmacological management can be one of the components to achieve better symptom control.
  
  
  
  To describe the anticipatory prescription of medication for symptomatic treatment and the deprescription of potentially inappropriate medication during the last days of life.
  
  
  
  This was a cross-sectional descriptive study between October 1, 2012 and September 30, 2013 in 23 acute geriatric wards in Flanders, Belgium. Structured after-death questionnaires were filled out by the treating geriatrician for patients hospitalized for more than 48 hours before dying.
  
  
  
  Anticipatory prescription of medication was present in 65.4% of cases, 45.5% of the cases was prescribed morphine, 15.5% benzodiazepines, and 13.8% scopolamine hydrobromide. A deprescription of potentially inappropriate medication was noted in 67.9% of cases. The likelihood of anticipatory prescription was significantly higher in cases where death was expected (odds ratio [OR] 19; 95% CI 9-40; P < 0.0001) and significantly lower where dementia was present (OR 0.35; 95% CI 0.16-0.74; P < 0.006). The likelihood of deprescription was higher in cases where death was expected (OR 20; 95% CI 10-43; P < 0.0001) and in cases of patients dying from an oncological disease compared with those dying from frailty or dementia (OR 7.0; 95% CI 1.1-45.6, P = 0.042).
  
  
  
  Anticipatory prescription of medication and deprescription of medication at the end of life in acute geriatric wards could be further optimized. A well-developed intervention to guide health care staff in patient-centered pharmacological management in the last days of life seems to be needed.
authors.affiliation: Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium. Electronic address: Nele.VanDenNoortgate@uzgent.be.
authors.forename: Nele J
authors.initials: NJ
authors.lastname: Van Den Noortgate
authors.affiliation: End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Verhofstede
authors.affiliation: End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium.
authors.forename: Joachim
authors.initials: J
authors.lastname: Cohen
authors.affiliation: Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium.
authors.forename: Ruth D
authors.initials: RD
authors.lastname: Piers
authors.affiliation: End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium.
authors.forename: Luc
authors.initials: L
authors.lastname: Deliens
authors.affiliation: End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium.
authors.forename: Tinne
authors.initials: T
authors.lastname: Smets
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium; D002423:Cause of Death; D003430:Cross-Sectional Studies; D000069340:Deprescriptions; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D000072219:Geriatricians; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000706:statistics & numerical data
keywords: Terminal care; acute geriatric ward; anticipatory prescribing; care during last 48 hours of life; deprescribing