Use of Potentially Inappropriate Medications in Older Patients Receiving Palliative Home Care: A Cross-Sectional Study
Abstract
Introduction. Population aging has led to a rise in chronic conditions such as major neurocognitive disorder, multimorbidity, and polypharmacy, increasing the likelihood of potentially inappropriate prescriptions in older adults. These individuals, often presenting with complex clinical conditions, have palliative care needs. The aim of this study is to describe the prevalence of potentially inappropriate medications and to identify the reasons preventing their discontinuation in older adults enrolled in a home care program. Methodology. Observational and descriptive study. The study population included 275 patients enrolled in the home care program of the Memory and Cognition Center “Intellectus” at Hospital Universitario San Ignacio between 2020 and 2021. Medical records of patients aged 60 years and older were reviewed. Data were analyzed using measures of dispersion and relative frequencies. Results. A total of 62.91% of the patients had palliative care needs (NECPAL positive), and 56.06% had potentially inappropriate prescriptions (STOPP-PAL), particularly proton pump inhibitors (17%), vitamins, calcium supplements, and antipsychotics. Although inappropriate medications were identified, some physicians opted to continue their use due to perceived clinical necessity, while others reported difficulties in communicating deprescribing decisions to patients and their families. Discussion. The literature reports a higher prevalence of inappropriate drug prescribing compared to the results of this study. When asked about the reasons for continuing this prescribing practice, physicians report that there is a perception of clinical need for the drug and, on the other hand, that adjustments to therapeutic goals are difficult to communicate to patients and their families. Comprehensive geriatric assessment is essential to improve the management of pharmacotherapy in patients with multimorbidity. Conclusions. A high prevalence of potentially inappropriate medications in this population highlights the need to improve communication and conduct comprehensive geriatric assessments to optimize pharmacological treatment.
References
1. Latorre-Santos C. El envejecimiento de la población. Oportunidades y retos. Rev Cienc salud [Internet]. 2019;17(3):6-8. doi: https://doi.org/10.12804/revistas.urosario.edu.co/revsalud/a.8347
2. Forman DE, Maurer MS, Boyd C, Brindis R, Salive ME, Horne FM, et al. Multimorbidity in Older Adults With Cardiovascular Disease. JAAC [Internet]. 2018;71(19):2149-61. doi: https://www.jacc.org/doi/10.1016/j.jacc.2018.03.022
3. Malakouti SK, Javan-Noughabi J, Yousefzadeh N, Rezapour A, Mortazavi SS, Jahangiri R, et al. A Systematic Review of Potentially Inappropriate Medications Use and Related Costs Among the Elderly. Value Health Reg Issues [Internet]. 2021;25:172-9. doi: https://doi.org/10.1016/j.vhri.2021.05.003
4. Gómez-Batiste X, Alentorn X. Capítulo 13 - Atención paliativa. En: Sanjuán AR, Farreras VP, editores. Medicina Clínica. 20.ª ed. Barcelona: Elsevier Spain; 2024. p. 58-63 p.
5. Gómez-Batiste X, Murray SA, Thomas K, Blay C, Boyd K, Moine S, et al. Comprehensive and Integrated Palliative Care for People With Advanced Chronic Conditions: An Update From Several European Initiatives and Recommendations for Policy. J Pain Symptom Manage [Internet]. 2017;53(3):509-17. doi: https://doi.org/10.1016/j.jpainsymman.2016.10.361
6. Gómez-Batiste X, Turrillas P, Tebé C, Calsina-Berna A, Amblàs-Novellas J. NECPAL tool prognostication in advanced chronic illness: a rapid review and expert consensus. BMJ Support Palliat Care [Internet]. 2022;12(e1):e10-e20. doi: https://doi.org/10.1136/bmjspcare-2019-002126
7. Delgado-Silveira E, Mateos-Nozal J, Muñoz-García M, Rexach-Cano L, Vélez-Díaz-Pallarés M, Albeniz-López J, et al. Inappropriate drug use in palliative care: SPANISH version of the STOPP-Frail criteria (STOPP-Pal). Rev Esp Geriatr Gerontol [Internet]. 2019;54(3):151-155. doi: https://doi.org/10.1016/j.regg.2018.11.008
8. Sánchez-Pérez H, Ramírez-Rosillo FJ, Carrillo-Esper R. Polifarmacia en el adulto mayor. Consideraciones en el perioperatorio. Rev mex anestesiol [Internet]. 2022;45(1):40-7. doi: https://dx.doi.org/10.35366/102902
9. Mozeluk NB, Acosta CMG, Ferre MFC, Bobillo M, Donnianni IB, Bellomo MJ, et al. Medicación potencialmente inapropiada en adultos mayores con necesidades paliativas en domicilio. Medicina (B Aires) [Internet]. 2024;84(3):487-495. Recuperado a partir de: https://pubmed.ncbi.nlm.nih.gov/38907963/
10. McNeil MJ, Kamal AH, Kutner JS, Ritchie CS, Abernethy AP. The Burden of Polypharmacy in Patients Near the End of Life. J Pain Symptom Manage [Internet]. 2016;51(2):178-183. doi: https://doi.org/10.1016/j.jpainsymman.2015.09.003
11. Omuya H, Nickel C, Wilson P, Chewning B. A systematic review of randomised-controlled trials on deprescribing outcomes in older adults with polypharmacy. Int J Pharm Pract [Internet]. 2023;31(4):349-68. doi: https://doi.org/10.1093/ijpp/riad025
12. Smith H, Miller K, Barnett N, Oboh L, Jones E, Darcy C, et al. Person-Centred Care Including Deprescribing for Older People. Pharmacy [Internet]. 2019;7(3):101. doi: https://doi.org/10.3390/pharmacy7030101
13. Jaramillo-Hidalgo J, Lozano-Montoya I, Tornero-Torres O, Tejada-González P, Fuentes-Irigoyen R, Gómez-Pavón FJ. Prevalence of potentially inappropriate prescription in community-dwelling patients with advanced dementia and palliative care needs. Rev Esp Geriatr Gerontol [Internet]. 2021;56(4):203-7. doi: https://doi.org/10.1016/j.regg.2021.03.001
14. Fuentes-Valenzuela E, Díez-Redondo P, Tejedor-Tejada J, Nájera-Muñoz R, Sánchez-Delgado L, Maroto-Martín C. Tratamiento con inhibidores de la bomba de protones. ¿Realmente lo necesita el paciente?. Medicina de Familia Semergen [Internet]. 2022;48(2):82-7. doi: https://doi.org/10.1016/j.semerg.2021.08.002
15. Llobet-Vila L, Manresa-Domínguez JM, Carmona-Segado JM, Franzi-Sisó A, Vallès-Balasch R, Martínez-Díaz I. Dilemas en la enfermedad crónica avanzada: ¿prevención o desprescripción? Aten Primaria [Internet]. 2018;50(10):583-9. doi: https://doi.org/10.1016/j.aprim.2017.05.016
16. Williamson LE, Evans CJ, Cripps RL, Leniz J, Yorganci E, Sleeman KE. Factors Associated With Emergency Department Visits by People With Dementia Near the End of Life: A Systematic Review. J Am Med Dir Assoc [Internet]. 2021;22(10):2046-2055. doi: https://doi.org/10.1016/j.jamda.2021.06.012
17. Feast A, Orrell M, Charlesworth G, Melunsky N, Poland F, Moniz-Cook E. Behavioural and psychological symptoms in dementia and the challenges for family carers: Systematic review. Br J Psychiatry [Internet]. 2016;208(5):429-34. doi: https://doi.org/10.1192/bjp.bp.114.153684
18. Vargas-Beltrán MP, Morros-González E, Hoyos-Porto SJ. Importancia y generalidades de la valoración geriátrica integral como herramienta de abordaje de la persona mayor en atención domiciliaria. Universitas Medica [Internet]. 2023;63(4). doi: https://doi.org/10.11144/Javeriana.umed63-4.vgih
19. O’Donnell LK, Ibrahim K. Polypharmacy and deprescribing: challenging the old and embracing the new. BMC Geriatr [Internet]. 2022;22(1):734. doi: https://doi.org/10.1186/s12877-022-03408-6
20. Pascual-López JA, Gil-Pérez T, Sánchez-Sánchez JA, Menárguez-Puche JF. ¿Cómo valorar la atención centrada en la persona según los profesionales? Un estudio Delphi. Aten Primaria [Internet]. 2022;54(1):102232. doi: https://doi.org/10.1016/j.aprim.2021.102232
Downloads
Copyright (c) 2025 MedUNAB
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
| Article metrics | |
|---|---|
| Abstract views | |
| Galley vies | |
| PDF Views | |
| HTML views | |
| Other views | |
