New thesis: Too much, too late? Drug prescribing for older people near the end of life

My thesis is about the burden of drug treatments among older people who are nearing the end of life. This topic is currently coming under greater scrutiny, because it appears that older people with serious illness and poor prognosis may be prescribed drugs that may do more harm than good, or continue to receive treatments that have little chance of achieving their benefit during the patients’ remaining lifetime.

Which are the most important results? 

The main findings are threefold. First, the number of drugs increases markedly throughout the last months of life, fueled not only by the initiation of symptomatic drugs to ensure comfort but also by the frequent continuation of preventive and disease-oriented treatments. Second, older adults who follow unpredictable end-of-life trajectories are not driving this observed increase in polypharmacy and in the continuation of preventive drugs. For instance, individuals who die with solid cancer (a set of diseases most often characterized by a very poor prognosis and a clinically discernible terminal phase) often keep receiving drugs for the long-term management of chronic comorbidities until the very end of life. Third, we provide clinically-driven, consensus-based  criteria to identify drugs considered ‘often adequate’, ‘questionable’, and ‘often inadequate’ for use in older persons aged ≥75 years with a life expectancy of 3 months or less.

How can this new knowledge contribute to the improvement of people’s health?

The findings from this thesis confirm that a large proportion of older people is most likely overtreated at the end of life, which exposes them to unnecessary risks. Deprescribing strategies integrated with palliative care are therefore warranted. In the absence of robust evidence from randomized controlled trials and well-designed observational studies, our criteria represent an important step forward in the on-going international effort to rationalize drug therapy among older people near the end of life. It is important to remember that deprescribing at the end of life is not about denying older people access to treatments that would be beneficial for them; it is about avoiding harmful side effects, maintaining the best possible quality of life despite the progression of the disease, and minimizing the disruptive impact of medicine on the patients’ everyday life.

What´s in the future for you? Will you keep on conducting research?

I will continue doing research. I just received a large research grant in France to lead a multidisciplinary study looking at the impact of overtreatment on older cancer patients’ health and quality of life. This project will involve a lot of collaboration with clinicians, which I am very much looking forward to!