Unnecessary Drugs at End-of-Life

As elderly nursing home residents approach end-of-life, the focus of medical care usually shifts from treating chronic conditions to managing pain and minimizing any other cause of discomfort.  But a recent study of almost 9,300 nursing home residents in Ontario, Canada, uncovered that nearly half of all elderly residents with dementia received potentially unnecessary drugs in their last week of life.

According to an April 10 CBC News report,  86 per cent of nursing home residents studied between 2010 and 2013 with advanced dementia were found to have received at least one drug with questionable benefits in the last four months of their lives.   Medications commonly prescribed that may have never been appropriate for patients with advanced dementia include drugs to lower cholesterol, blood thinners, sex hormones and anti-dementia drugs which can cause loss of appetite or upset stomach.

If the goal is to keep elderly patients as comfortable as possible as they near end-of-life, careful attention should be paid to what medications are truly necessary.  The cost associated with prescribing potentially harmful medications to seniors in Canada is estimated at $419 million each year and with the growing concern over dangerous drug interactions and over-prescribing, caregivers and physicians are beginning to see the benefit of cutting out unnecessary prescriptions.

Focusing on quality of life for older nursing home residents with advanced dementia is generally recommended by geriatric care experts however, it is still common for elderly patients to continue to receive aggressive drug therapies as they approach end-of-life.

According to the Canadian Institute for Health Information, two out of three seniors in Canada take at least five different medications and inappropriate prescriptions, including sedatives, can lead to an increased risk for falls, hospitalization and death.   Taking multiple medications can affect balance and cause cognitive problems among seniors who can be more sensitive to drug side effects.

Older adults who take multiple prescription medications should have their drugs regularly reviewed by their doctor and pharmacist to determine if there are drugs that no longer offer any benefit or could present a danger.  Do not start or stop any prescription medication without first consulting your health care practitioner and always keep an up-to-date list of all medications and dosages. A Medication Checklist is available in the Toolkit with a free membership to The Oldish.

To read more about the study, published in the Journal of the American Geriatrics Society, visit  http://onlinelibrary.wiley.com/doi/10.1111/jgs.14844/abstract .