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Polypharmacy in the terminally ill

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To the Editor: A significant number of patients who receive palliative care are over 65 years of age. In addition to their terminal illness, they often have other medical comorbidities. Long-term medical management of these conditions can evolve into a large regimen of medications. Patients may continue to take these medications as they enter the terminal phase of their illness, but it is often unnecessary and to their detriment.1

We performed a retrospective chart review between 8 July and 6 October 2010 to determine the prevalence of polypharmacy in 50 consecutive patients aged over 65 years who were admitted to the Palliative Care Unit (PCU) at Redcliffe Hospital and who died during that admission. Because patients receiving palliative care are invariably prescribed several medications for symptom control (analgesics, laxatives and antiemetics), we adopted a liberal total as the cut-off and deemed that nine or more medications constituted polypharmacy for this cohort.

The mean age of patients was 76.9 years and 17 were women. Polypharmacy was prevalent (21 patients). The median number of medications per patient on admission was seven, with men prescribed a median of seven, and women a median of eight. Patients aged 66–74 years were on a median of 10 medications…