Prescribing of inappropriate medicine in patients with limited life expectancy : a prospective study in a specialist palliative care unit

Abstract

For patients with limited life expectancy – typically surviving for less than one year – polypharmacy is very common because medication is prescribed to manage acute symptoms associated with the life limiting illness (e.g. cancer) and to treat or prevent other long-term conditions (e.g. cardiovascular disease). As a consequence, this polypharmacy is linked with an increased risk of developing a drug-related toxicity due to the potential of drug-drug or drug-disease interactions. This risk is further heightened in patients with limited life expectancy owing to their unique and dynamic pharmacokinetic and pharmacodynamic parameters (e.g. variation in volume of distribution or altered drug excretion due to declining renal and/or hepatic function). In view of the potential for polypharmacy to cause harm in patients with limited life expectancy, it is essential to optimize patients’ medication to align with therapeutic goals and life expectancy. To date, however, there is a growing body of evidence that suggests inappropriate medication continues to be prescribed to patients with limited life expectancy.