Anlay DZ, Paque K, Brys ADH, Cohen J, Dilles T. Balancing palliative care needs and medication appropriateness: Initiation and reinitiation of medications at the end of life. Arch Gerontol Geriatr. 2025 Aug 23;139:105994. doi: 10.1016/j.archger.2025.105994.
Abstract
Background: Medications deemed inappropriate and discontinued in the earlier stages of life-limiting disease may become relevant in palliative care context at the end of life. This study aims to determine the incidence of and factors associated with initiation and reinitiation of medications deemed inappropriate according to the STOPPFrail guideline.
Methods: A retrospective cohort study using linked healthcare reimbursement data. We included nursing home residents aged ≥65 who died with a condition potentially amenable to palliative care between 2015 and 2019 in Belgium. Outcomes were: (1) reinitiation of previously discontinued STOPPFrail-listed medications; and (2) initiation of these medications, regardless of prior use, in the last three months. Log-binomial regression was used to estimate relative risks (RR) with 95 % confidence intervals (CI).
Results: Among 158,689 decedents, 29.7 % had at least one medication initiated, and 16.96 % reinitiated among those with at least one medication discontinued (n = 13,724). By medication type, initiation and reinitiation were significantly higher for symptomatic medications than preventive ones (initiation: 25.5 % symptomatic vs. 6.7 % preventive; reinitiation: 20.3 % symptomatic vs. 11 % preventive). The risk was higher among residents with cancer, who were hospitalized, or taking ≥10 chronic medications.
Conclusions: A significant proportion of residents undergo initiation or reinitiation of medications deemed inappropriate at the end of life per existing guidelines. Many were likely prescribed for palliative purposes. Thus, guidelines on medication appropriateness may need to more explicitly address palliative care contexts. A notable number also received preventive medications, suggesting inappropriate prescribing at the end of life that has received little attention.
Keywords: Cohort study; Drug utilization; End of life; Nursing homes; Palliative care; Potentially Inappropriate Medication List.
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