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Adequate, questionable, and inadequate drug prescribing for older adults at the end of life: a European expert consensus
Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Catholic University of Rome, Italy.
Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
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Number of Authors: 52018 (English)In: European Journal of Clinical Pharmacology, ISSN 0031-6970, E-ISSN 1432-1041, Vol. 74, no 10, p. 1333-1342Article in journal (Refereed) Published
Abstract [en]

Background

Clinical guidance is needed to initiate, continue, and discontinue drug treatments near the end of life.

Aim

To identify drugs and drug classes most often adequate, questionable, or inadequate for older people at the end of life.

Design

Delphi consensus survey.

Setting/participants

Forty European experts in geriatrics, clinical pharmacology, and palliative medicine from 10 different countries. Panelists were asked to characterize drug classes as “often adequate,” “questionable,” or “often inadequate” for use in older adults aged 75 years or older with an estimated life expectancy of ≤ 3 months. We distinguished the continuation of a drug class that was previously prescribed from the initiation of a new drug. Consensus was considered achieved for a given drug or drug class if the level of agreement was ≥ 75%.

Results

The expert panel reached consensus on a set of 14 drug classes deemed as “often adequate,” 28 drug classes deemed “questionable,” and 10 drug classes deemed “often inadequate” for continuation during the last 3 months of life. Regarding the initiation of new drug treatments, the panel reached consensus on a set of 10 drug classes deemed “often adequate,” 23 drug classes deemed “questionable,” and 23 drug classes deemed “often inadequate”. Consensus remained unachieved for some very commonly prescribed drug treatments (e.g., proton-pump inhibitors, furosemide, haloperidol, olanzapine, zopiclone, and selective serotonin reuptake inhibitors).

Conclusion

In the absence of high-quality evidence from randomized clinical trials, these consensus-based criteria provide guidance to rationalize drug prescribing for older adults near the end of life.

Place, publisher, year, edition, pages
2018. Vol. 74, no 10, p. 1333-1342
Keywords [en]
Palliative care, Older adults, Drug prescribing, Quality of care, Inappropriate prescribing
National Category
Social and Clinical Pharmacy Geriatrics
Identifiers
URN: urn:nbn:se:su:diva-161178DOI: 10.1007/s00228-018-2507-4ISI: 000444387700013PubMedID: 29934849OAI: oai:DiVA.org:su-161178DiVA, id: diva2:1261075
Available from: 2018-11-06 Created: 2018-11-06 Last updated: 2018-11-06Bibliographically approved

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Citation style
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