Why less is more when it comes to medication use at the end of life

April 17 2020

By Charlotte Aitken, one of our awesome Summer students. Her project ended up as a publication in Palliative Medicine. 

During the summer of 2018/19 I was lucky enough to be awarded a Summer Research Scholarship with Dr Aileen Collier and Associate Professor Michal Boyd. As a result of the generous funding from Choosing Wisely, we were able to carry out a scoping review of medication use in aged care residents during the last year of life.

As a final year medical student, I have had placements in general medicine, older persons health, nursing homes and hospice facilities. During these placements, I have seen first-hand several hospital admissions caused by polypharmacy and adverse drug reactions. I have also seen the issues faced by physicians trying to juggle the large number of mediations older people are on towards the end of life. Therefore, it was incredibly interesting to delve into this area of research as part of this project.

A substantial number of older adults die in residential aged care. Despite this, little is known about the characteristics of their medication use, and how medication use can best be optimised during the last year of life. By doing this scoping review, we aimed to map characteristics of medication use in age care residents during their last year of life and examine key concepts related to medication safety.

We identified 30 relevant papers from our search and these were subsequently reviewed. The analysis process revealed five key overarching themes:  (1) access to medicines at the end of life, (2) categorisation and classes: medicines and populations, (3) polypharmacy and total medication numbers, (4) use of symptomatic versus preventive medications and (5) ‘inappropriate’ medications.

This scoping review has characterised the complexities of medication use by aged care residents at the end of life. It has revealed that simply looking at the number of prescriptions or blunt categorisation of medications to assess their appropriateness is not sufficient. Individualised approaches and/or interventions are needed for the residential aged care facility population. These approaches need to be underpinned by the combined expertise of geriatric and palliative care specialists.