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Arch Intern Med. 2006;166:605-609.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

INTRODUCTION

Providing guideline-adherent care for many medical conditions increasingly means the addition of more medications to reach disease-specific targets.¹ When might it be best to withhold or discontinue medications that are otherwise appropriate on the basis of guidelines? Receiving facsimiles from the pharmacy serving a local nursing home encouraging us to prescribe statins for residents there symbolizes the issues. Most of these patients had a limited life expectancy, were older than 90 years, or had advanced dementia. Similar situations occur in patients with functional impairments, frailty, or diseases like emphysema, congestive heart failure, or coronary artery disease in their advanced stages, for whom starting or continuing many recommended drugs does not seem the best way to optimize care.

Investigators in a number of studies^2-4 have characterized inappropriate prescribing in the elderly, but there is little information to guide discontinuation of otherwise indicated medications in patients late in life. We propose a . . . [Full Text of this Article]

APPROPRIATE PRESCRIBING IN THE ELDERLY

A MODEL FOR APPROPRIATE PRESCRIBING FOR PATIENTS LATE IN LIFE

REMAINING LIFE EXPECTANCY

TIME UNTIL BENEFIT

GOALS OF CARE

TREATMENT TARGETS

CASE STUDIES WITH THE MODEL

Case 1

Case 2

Case 3

COMMENT

AUTHOR INFORMATION

Holly M. Holmes, MD; Déon Cox Hayley, DO; G. Caleb Alexander, MD, MS; Greg A. Sachs, MD

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