Needless Medications Common in Final Stage of Life, Dutch research Finds
Amsterdam, Netherlands – A significant proportion of patients in their final phase of life are continuing to receive medications with questionable benefit, according to new research from the Netherlands Institute for Health Services Research (Nivel). The study reveals that 75% of patients received repeat prescriptions for drugs like those used to treat heart failure and acid reflux, where the continued usefulness is often uncertain given their condition.
The findings, published this week, highlight a persistent issue of perhaps burdensome polypharmacy – the use of multiple medications – for individuals nearing the end of life. “People who are terminally ill frequently enough get ten or more different medicines,” explains Yvonne de Man, a researcher at Nivel. “Certainly if you are weakened and have a hard time swallowing, it is very annoying to have to take them all. Than you are happy with every pill that you can delete from the list. We are not yet talking about the possible side effects, the costs and the sustainability aspect.”
while the percentage of repeat prescriptions for potentially inappropriate medication has decreased from 70% in 2017 to 63% in 2023, de man suggests this indicates a growing awareness among general practitioners regarding appropriate medication use in palliative care.
However, challenges remain. De Man notes the difficulty doctors face in accurately predicting a patient’s remaining lifespan, impacting decisions about continuing or discontinuing treatment. She points to tools like the “Surprise Question” – “Would I be surprised if this person dies within a year?” – as a potential aid in reassessing medication regimens.The study also found that over 60% of patients received pain medication in their final phase, with 65% of those prescribed opioids also receiving laxatives, as recommended by guidelines to combat opioid-induced constipation. Despite these guidelines, de Man notes inconsistencies in their submission, stating, “It’s a shame that this doesn’t always happen.”
Daphne Laeijendecker, spokesperson for the Dutch GP Society (NHG), acknowledges the complexities of medication review. “Stopping prescribing certain medicines can give a patient the feeling that he is giving up,” she explains, referencing the psychological impact on patients. She also notes that discontinuing medication can sometimes trigger unwanted side effects requiring a phased withdrawal, which may not always be suitable.
Researchers hope the findings will encourage greater awareness among general practitioners, emphasizing the importance of recognizing the palliative phase and prioritizing patient wishes and needs.
