end-of-life

Deprescribing medicines at end of life

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Almost half of older adults receive more than 10 prescription drugs in the last year of life.

“Physicians should consider discontinuing drugs that may be effective and otherwise appropriate but whose potential harms outweigh the benefits that patients can reasonably expect before death occurs.”

That’s according to the authors of a new study of more than 500,000 older adults which found, over the course of the final year of life, the proportion of individuals exposed to ≥10 different drugs rose from 30.3 per cent to 47.2 per cent. Analgesics, anti-thrombotic agents, diuretics, psycholeptics and β-blockers were the five most commonly used drug classes. More than a fifth received angiotensin-converting enzyme inhibitors and 15.8 per cent received statins during their final month of life.

Writing in the American Journal of Medicine the authors said polypharmacy raises important ethical questions about the potential futility of treatments close to death. “People with life-limiting illness often receive medications whose benefit is unlikely to be achieved within their remaining lifespan,” they said.

While deprescribing is supported by a growing body of evidence, the authors said firm guidelines are needed to support physicians in their decision to continue or discontinue drug treatments near the end of life. When deprescribing does occur, it requires “timely dialogue” with patients and their families, they said.

How should healthcare professionals discuss death with children?

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New draft guidelines say social media can be useful when talking to children about death.

Doctors are being asked to think about how they provide information to children and young people with life-limiting conditions. Where appropriate, conversations about end-of-life should incorporate tools such as social media and play.

The recommendations are included in new draft guidelines on the planning and management of end-of-life care for infants, children and young people, which have just been published by the UK National Institute for Health and Care Excellence (NICE).

The guidelines state doctors should take their patient’s age and level of understanding into consideration when discussing their condition and can use tools such as social media, play and art to convey information to them.

The document also says that it is important that healthcare professionals ensure children and their carers are given enough time and opportunities for discussion when difficult decisions need to be made about end-of-life care.

Healthcare professionals should also be aware of the importance of talking about dying, the document states, adding that if appropriate, they should discuss whether a child or young person wants to and is able to talk about dying.

The final recommendations are due to be published in December 2016.