CAN WE CHANGE THE POLICY OF PRESCRIBING COMMON MEDICATIONS UNTIL DEATH?

摘要

“Preventive” medications for common diseases have proven efficacy in relatively healthy adults. Prescribing these to the >very >old, with >co-morbidity, >dementia, >frailty and >limited life->expectancy (VOCODFLEX) is harmful. We evaluated medications given to end-stage cancer patients (ESCP) upon admission to Homecare Hospice, Israel Cancer Association. 202 ESCP, average age 80, average Hospice stay until death 39 days. Average number of common medications 9.2, 63% consumed 6–12, 23% 12–22 drugs. 2 months before death, 22% were still on aspirin for “vascular problems prevention”, 60% were prescribed at least one, 17% ≥3 Blood Pressure lowering drugs, 30% were still on statins “to lower serum cholesterol”. Oncologists do not change medications prescribed by other experts and vice versa. ESCP continue to visit family physicians/experts who continue to prescribe based on “their guidelines”–unproven in this sub-population. “Defensive medicine guidelines” may be harming most vulnerable subpopulations. Who is responsible for stepping on the brakes?