naa a22 4500 510740383 CHVBK 20180411083026.0 cr unu---uuuuu 180411e20130301xx s 000 0 eng 10.1007/s11845-012-0841-6 doi (NATIONALLICENCE)springer-10.1007/s11845-012-0841-6 Pharmacological management of co-morbid conditions at the end of life: is less more? [Elektronische Daten] [S. McLean, B. Sheehy-Skeffington, N. O'Leary, A. O'Gorman] Background: Co-morbid conditions (CMCs) are present in over half of patients with cancer over 50years of age. As life-limiting illnesses progress, the benefits and burdens of treatments for CMCs become unclear. Relevant issues include physiological changes in advanced illness, time-to-benefit of medications, burden of medications, and psychological impact of discontinuing medications. Optimal prescribing is unclear due to lack of evidence. Objectives: The objectives are to determine prescribing practice, for CMCs, in a single SPC service. Methods: Patients referred to a single specialist palliative care (SPC) service, who died between 1/8/2010 and 30/9/2012, were identified. Medical notes were reviewed, and data collected on prescribing at 3months, 1month, and 1week prior to death. Results: Fifty-two patients with a median age of 74.5years were identified; 41 patients (79%) had a malignant condition.50% died in hospital. Patients had a mean of three CMCs. A mean of 4.6 medications for CMCs were prescribed to patients over 65. A mean of 10 medications in total were prescribed at 1week before death. One week before death, one-third of patients continued to be prescribed aspirin, and over one-quarter a statin. Conclusions: Total medication burden increases as time to death shortens, due to continuation of medications for CMCs, and addition of medications for symptom control. There is a need for research to demonstrate the impact of polypharmacy at the end of life, in order to formulate a framework to guide practice. Royal Academy of Medicine in Ireland, 2012 Palliative nationallicence Co-morbid nationallicence Polypharmacy nationallicence Prescribing nationallicence End of life nationallicence McLean S. Specialist Palliative Care Service, Dochas Centre, Our Lady of Lourdes Hospital, Drogheda, Co. Louth, Ireland aut Sheehy-Skeffington B. Specialist Palliative Care Service, Dochas Centre, Our Lady of Lourdes Hospital, Drogheda, Co. Louth, Ireland aut O'Leary N. Specialist Palliative Care Service, Dochas Centre, Our Lady of Lourdes Hospital, Drogheda, Co. Louth, Ireland aut O'Gorman A. Specialist Palliative Care Service, Dochas Centre, Our Lady of Lourdes Hospital, Drogheda, Co. Louth, Ireland aut Irish Journal of Medical Science Springer-Verlag 182/1(2013-03-01), 107-112 0021-1265 182:1<107 2013 182 11845 https://doi.org/10.1007/s11845-012-0841-6 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s11845-012-0841-6 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- McLean S. Specialist Palliative Care Service, Dochas Centre, Our Lady of Lourdes Hospital, Drogheda, Co. Louth, Ireland aut NATIONALLICENCE 700 1- Sheehy-Skeffington B. Specialist Palliative Care Service, Dochas Centre, Our Lady of Lourdes Hospital, Drogheda, Co. Louth, Ireland aut NATIONALLICENCE 700 1- O'Leary N. Specialist Palliative Care Service, Dochas Centre, Our Lady of Lourdes Hospital, Drogheda, Co. Louth, Ireland aut NATIONALLICENCE 700 1- O'Gorman A. Specialist Palliative Care Service, Dochas Centre, Our Lady of Lourdes Hospital, Drogheda, Co. Louth, Ireland aut NATIONALLICENCE 773 0- Irish Journal of Medical Science Springer-Verlag 182/1(2013-03-01), 107-112 0021-1265 182:1<107 2013 182 11845 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer