Friday, June 2, 2017

Dying Patients Often Given Medicines That Won’t Help Them

As older people approach the end of life, many are being prescribed drugs of questionable benefit, a new study shows.

“People with life-limiting illness often receive medications whose benefit is unlikely to be achieved within their remaining life span,” said study author Lucas Morin. He is from the Aging Research Center at Karolinska Institute in Stockholm.

The study included more than a half a million people, aged 65 and older, in Sweden. All died between 2007 and 2013. The proportion of patients getting at least 10 different drugs rose from 30 to 47% during the year before death, the findings showed.

People who died from cancer had the largest increase in the number of drugs. Those living in institutions were given more medications than people living in the community. But the number of drugs increased more slowly for those living in an institution, the investigators found.

Many patients were given a high number of drugs near the end of life to control symptoms. But for some, long-term preventive mediations or disease-specific drugs were also continued until the end of life, according to the report.

For example, during the last month of life, almost half of patients used drugs to keep blood platelets from sticking together and forming blood clots. Another 41% were taking heart medications called beta-blockers. Fifteen percent were taking another type of heart medication called a calcium channel blocker.

Blood pressure medications, such as ACE inhibitors (21%), vasodilators (17%), or potassium-sparing medications (12%) also were given during the last month of life. About 16% of people in the study were taking cholesterol-lowering medications, known as statins.

The report was published online May 15 in The American Journal of Medicine.

“The clinical benefit of drugs aiming at preventing cardiovascular diseases during the final month of life is at the very least questionable,” the study authors wrote. “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,” the researchers added.

My Take:
Eighty percent of all the health care dollars you spend during your life will be spent the last six weeks – and then you die. Continuing unnecessary and even potentially harmful prescriptions near end of life is just the tip of the iceberg.

Prescribing medications seems to be a one way street. With few exceptions, once you are placed on a drug, you stay on it forever. That is unless another drug or two replaces it.

The hypertensive drugs – beta blockers, calcium channel blockers and ACE inhibitors are often where this vicious cycle begins. Once you slow the force of the heart contraction with any of these drugs, edema develops especially in the lower extremities. The treatment is generally a diuretic. The diuretic robs the body of potassium, so now a prescription potassium supplement is added. However, it irritates the digestive tract, so a PPI is added. PPIs (proton pump inhibitors) are recommended for 2 to 8 weeks but I routinely see patients on all these meds for years and years.

The Bottom Line:

If you have a friend or family member that is approaching end of life urge them to have a medication review. It could greatly enhance their quality of life and maybe even the longevity.

Source: May 19, 2017 National Institutes of Health

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