1. Adequate, questionable, and inadequate drug prescribing for older adults at the end of life: a European expert consensus
- Author
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Johan Fastbom, Marie-Laure Laroche, Lucas Morin, Kristina Johnell, and Davide L. Vetrano
- Subjects
Drug ,Olanzapine ,medicine.medical_specialty ,Consensus ,Prescription Drugs ,Palliative care ,Delphi Technique ,Pharmacoepidemiology and Prescription ,media_common.quotation_subject ,Inappropriate prescribing ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Surveys and Questionnaires ,Drug prescribing ,Humans ,Medicine ,Pharmacology (medical) ,030212 general & internal medicine ,Practice Patterns, Physicians' ,Intensive care medicine ,Potentially Inappropriate Medication List ,Aged ,media_common ,Pharmacology ,Geriatrics ,Terminal Care ,Clinical pharmacology ,business.industry ,Quality of care ,General Medicine ,Drug class ,Older adults ,030220 oncology & carcinogenesis ,Life expectancy ,business ,medicine.drug - Abstract
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. Electronic supplementary material The online version of this article (10.1007/s00228-018-2507-4) contains supplementary material, which is available to authorized users.
- Published
- 2018