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Reconsidering Medication Appropriateness for Patients Late in Life
Arch Intern Med. 2006;166:605-609.
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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 studies2-4 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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