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Adequate, questionable, and inadequate drug prescribing for older adults at the end of life: a European expert consensus.

ABSTRACT: Clinical guidance is needed to initiate, continue, and discontinue drug treatments near the end of life.To identify drugs and drug classes most often adequate, questionable, or inadequate for older people at the end of life.Delphi consensus survey.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%.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).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.

SUBMITTER: Morin L

PROVIDER: S-EPMC6132505 | biostudies-other | 2018 Jun

REPOSITORIES: biostudies-other

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Adequate, questionable, and inadequate drug prescribing for older adults at the end of life: a European expert consensus.

Morin Lucas L Laroche Marie-Laure ML Vetrano Davide L DL Fastbom Johan J Johnell Kristina K

European journal of clinical pharmacology 20180623 10

<h4>Background</h4>Clinical guidance is needed to initiate, continue, and discontinue drug treatments near the end of life.<h4>Aim</h4>To identify drugs and drug classes most often adequate, questionable, or inadequate for older people at the end of life.<h4>Design</h4>Delphi consensus survey.<h4>Setting/participants</h4>Forty European experts in geriatrics, clinical pharmacology, and palliative medicine from 10 different countries. Panelists were asked to characterize drug classes as "often ade ...[more]

PMID: 29934849

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Project description:BackgroundAdequate access to healthcare is associated with lower risks of mortality at older ages. However, it is largely unknown how many more years of life can be attributed to having adequate access to healthcare compared with having inadequate access to healthcare.MethodA nationwide longitudinal survey of 27,794 older adults aged 65+ in mainland China from 2002 to 2014 was used for analysis. Multivariate hazard models and life table techniques were used to estimate differences in life expectancy associated with self-reported access to healthcare (adequate vs. inadequate). The findings were assessed after adjusting for a wide range of demographic factors, socioeconomic status, family/social support, health practices, and health conditions.ResultsAt age 65, adequate access to healthcare increased life expectancy by approximately 2.0-2.5 years in men and women and across urban-rural areas compared with those who reported inadequate access to healthcare. At age 85, the corresponding increase in life expectancy was 1.0-1.2 years. After adjustment for multiple confounding factors, the increase in life expectancy was reduced to approximately 1.1-1.5 years at age 65 and 0.6-0.8 years at age 85. In women, the net increase in life expectancy attributable to adequate access to healthcare was 6 and 8% at ages 65 and 85, respectively. In men, the net increases in life expectancy were generally greater (10 and 14%) and consistent after covariate adjustments. In contrast, the increase in life expectancy was slightly lower in rural areas (2.0 years at age 65 and 1.0 years at age 85) than in urban areas (2.1 years at age 65 and 1.1 years age 85) when no confounding factors were taken into account. However, the increase in life expectancy was greater in rural areas (1.0 years at age 65 and 0.6 years at age 85) than in urban areas (0.4 years at age 65 and 0.2 years at age 85) after accounting for socioeconomic and other factors.ConclusionsAdequate access to healthcare was associated with longer life expectancy among older adults in China. These findings have important implications for efforts to improve access to healthcare among older populations in China.

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Adequate, questionable, and inadequate drug prescribing for older adults at the end of life: a European expert consensus.

Publications

Adequate, questionable, and inadequate drug prescribing for older adults at the end of life: a European expert consensus.

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