Discontinuation of Preventive Medicines in Older People with Limited Life Expectancy: A Systematic Review.

Abstract:

BACKGROUND:In the presence of multimorbidity and limited life expectancy (LLE), the need for continued use of preventive medicines becomes uncertain as they may neither improve health nor confer continued health benefits. OBJECTIVE:Our objective was to systematically review the literature to examine the discontinuation of preventive medicines in older people with LLE. METHODS:A systematic literature search was conducted using the Ovid MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Central Register databases. Studies investigating discontinuation of preventive medicines in older individuals (mean age ≥65 years) with LLE (≤12 months) published between 1 January 1997 and 28 February 2017 were included. The Cochrane risk-of-bias assessment criteria and the Newcastle-Ottawa Scale were used to assess the quality of the studies. RESULTS:Ten studies-a randomized controlled trial (RCT), two case-control studies, and seven cohort studies-involving 26,854 participants with a mean age ranging from 66.0 to 85.0 years were included in this review. The studies were primarily conducted in palliative care (n = 3), residential facility (n = 2), and community (n = 1) settings, and the remainder were pharmacoepidemiological studies (n = 4). The most common life-limiting illnesses were cancer (n = 5), followed by other unspecified illnesses (n = 4) and advanced dementia (n = 1). The most common preventive medicine discontinued was statins, followed by warfarin and aspirin. LLE potentially prompted discontinuation; however, some individuals continued to receive preventive medicines until they died. CONCLUSIONS:The review found that withdrawal of preventive medicines at the end of life is challenging. Decisions about the discontinuation of preventive medicines for individuals approaching the end of life are increasingly complicated by the lack of clear deprescribing guidelines for these medicines.

journal_name

Drugs Aging

journal_title

Drugs & aging

authors

Narayan SW,Nishtala PS

doi

10.1007/s40266-017-0487-1

subject

Has Abstract

pub_date

2017-10-01 00:00:00

pages

767-776

issue

10

eissn

1170-229X

issn

1179-1969

pii

10.1007/s40266-017-0487-1

journal_volume

34

pub_type

杂志文章,评审
  • Anticholinergic component of the Drug Burden Index and the Anticholinergic Drug Scale as measures of anticholinergic exposure in older people in New Zealand: a population-level study.

    abstract:BACKGROUND:Older people are exposed to multiple medicines that possess anticholinergic properties. The use of anticholinergic medicines is associated with the risk of morbidity, mortality and cognitive decline, particularly in older people. Anticholinergic exposure can be measured using tools such as the Drug Burden In...

    journal_title:Drugs & aging

    pub_type: 杂志文章

    doi:10.1007/s40266-013-0111-y

    authors: Narayan SW,Hilmer SN,Horsburgh S,Nishtala PS

    更新日期:2013-11-01 00:00:00

  • Managing Gout in the Patient with Renal Impairment.

    abstract::Hyperuricaemia is an independent risk factor for renal function decline. Evidence is emerging that urate-lowering therapy might be beneficial in subjects with renal impairment. We  review the association between renal impairment and gout, some of the related pathogenic processes and the possible impact of gout treatme...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审

    doi:10.1007/s40266-018-0517-7

    authors: Pascual E,Sivera F,Andrés M

    更新日期:2018-04-01 00:00:00

  • Is there a role for a mucosal influenza vaccine in the elderly?

    abstract::Influenza infection is an acute respiratory disease with a high morbidity and significant mortality, particularly among the elderly and individuals with chronic diseases. The majority of countries now recommend annual influenza vaccination for all people aged 65 years or older, and for those with high risk conditions....

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审

    doi:10.2165/00002512-199915030-00001

    authors: Corrigan EM,Clancy RL

    更新日期:1999-09-01 00:00:00

  • Psychotropic drug-induced falls in older people: a review of interventions aimed at reducing the problem.

    abstract::Falls are a common health problem for older people, and psychotropic medications have been identified as an important independent fall risk factor. The objective of this paper was to review the literature relating to the effect of psychotropic medications on falls in older people, with a particular focus on evidence s...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审

    doi:10.2165/11598420-000000000-00000

    authors: Hill KD,Wee R

    更新日期:2012-01-01 00:00:00

  • Potential Statin Overuse in Older Patients: A Retrospective Cross-Sectional Study Using French Health Insurance Databases.

    abstract:BACKGROUND:Although compelling evidence exists supporting statins (HMG-CoA reductase inhibitors) for secondary prevention in older patients with clinical atherosclerotic diseases, the same cannot be said for primary prevention. OBJECTIVES:The objectives of this study were to estimate the frequency of potential statin ...

    journal_title:Drugs & aging

    pub_type: 杂志文章

    doi:10.1007/s40266-019-00695-4

    authors: Borne E,Meyer N,Rybarczyck-Vigouret MC,Blanchard O,Lombard M,Lang PO,Vogel T,Michel B

    更新日期:2019-10-01 00:00:00

  • Challenges and promises in the development of neurotrophic factor-based therapies for Parkinson's disease.

    abstract::Parkinson's disease (PD) is a chronic movement disorder typically coupled to progressive degeneration of dopaminergic neurons in the substantia nigra (SN). The treatments currently available are satisfactory for symptomatic management, but the efficacy tends to decrease as neuronal loss progresses. Neurotrophic factor...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审

    doi:10.1007/s40266-014-0160-x

    authors: Rodrigues TM,Jerónimo-Santos A,Outeiro TF,Sebastião AM,Diógenes MJ

    更新日期:2014-04-01 00:00:00

  • NSAID use and the risk of Parkinson's disease: systematic review and meta-analysis of observational studies.

    abstract:BACKGROUND:Several studies have suggested that NSAID use may modify the risk of developing Parkinson's disease (PD). OBJECTIVE:Our aim was to conduct a meta-analysis of observational studies evaluating NSAID use and the risk of PD. METHODS:We systematically searched MEDLINE (1966-November 2008), EMBASE (1980-November...

    journal_title:Drugs & aging

    pub_type: 杂志文章,meta分析,评审

    doi:10.2165/11316780-000000000-00000

    authors: Samii A,Etminan M,Wiens MO,Jafari S

    更新日期:2009-01-01 00:00:00

  • Cost effectiveness of withdrawal of fall-risk-increasing drugs in geriatric outpatients.

    abstract:BACKGROUND:Withdrawal of fall-risk-increasing drugs has been proven to be effective in older persons. However, given the enormous rise in healthcare costs in recent decades, the effect of such withdrawals on healthcare costs also needs to be considered. METHOD:Within a common geriatric outpatient population, patients ...

    journal_title:Drugs & aging

    pub_type: 杂志文章

    doi:10.2165/00002512-200825060-00005

    authors: van der Velde N,Meerding WJ,Looman CW,Pols HA,van der Cammen TJ

    更新日期:2008-01-01 00:00:00

  • Treatment of Overactive Bladder in the Elderly Female: The Case for Trospium, Oxybutynin, Fesoterodine and Darifenacin.

    abstract::Overactive bladder (OAB) is a common constellation of lower urinary tract storage symptoms that causes a significant impact on a person's quality of life. The elderly may be disproportionally impacted by these symptoms due to concomitant poor mobility, comorbid conditions such as diabetes and heart failure, and polyph...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审

    doi:10.1007/s40266-015-0301-x

    authors: McFerren SC,Gomelsky A

    更新日期:2015-10-01 00:00:00

  • Do we need drug therapy to manage mild hypertension in the elderly?

    abstract::Mild hypertension (grade 1 or stage 1 hypertension) is defined as a systolic blood pressure of 140-159 mm Hg or a diastolic pressure of 90-99 mm Hg. According to current guidelines, patients with mild hypertension can be at low, medium, high or very high risk depending on the presence of other risk factors, target org...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审

    doi:10.2165/00002512-200421010-00001

    authors: Fagard RH

    更新日期:2004-01-01 00:00:00

  • Epidemiology and optimal management of polymyalgia rheumatica.

    abstract::Polymyalgia rheumatica (PMR) is a disease of unknown aetiology that occurs in elderly patients, predominantly affecting the Caucasian population. The disease has a slightly higher prevalence in women than in men. There is ongoing discussion regarding the relationship between PMR and giant cell arteritis; an increasing...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审

    doi:10.2165/00002512-199813020-00003

    authors: Labbe P,Hardouin P

    更新日期:1998-08-01 00:00:00

  • Age-related changes in male gonadal function. Implications for therapy.

    abstract::In contrast with women, who experience a complete and abrupt cessation of ovarian function during the menopause, aging men largely maintain their testicular androgen production. Nevertheless, most cross-sectional studies indicate that there is a partial decrease in testosterone levels with aging, although this has not...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审

    doi:10.2165/00002512-199711010-00005

    authors: Maas D,Jochen A,Lalande B

    更新日期:1997-07-01 00:00:00

  • Effect of reproductive hormones and selective estrogen receptor modulators on mood during menopause.

    abstract::Periods of intense hormonal fluctuations have been associated with heightened prevalence and exacerbation of underlying psychiatric illness, particularly the occurrence of premenstrual dysphoria, puerperal depression and depressive symptoms during perimenopause. It has been speculated that sex steroids such as estroge...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审

    doi:10.2165/00002512-200320020-00001

    authors: Soares CN,Poitras JR,Prouty J

    更新日期:2003-01-01 00:00:00

  • Optimal pharmacotherapeutic management of acute lymphoblastic leukaemia in the elderly.

    abstract::The main characteristic of acute lymphoblastic leukaemia (ALL) in the elderly is its dismal prognosis. However, other than a lower incidence of T-cell ALL and a greater likelihood of unfavourable chromosomal abnormalities, the clinical and biological characteristics of Philadelphia chromosome-negative (Ph-) ALL in the...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审

    doi:10.2165/11592850-000000000-00000

    authors: Rousselot P,Delannoy A

    更新日期:2011-09-01 00:00:00

  • Update on oral cyanocobalamin (vitamin B12) treatment in elderly patients.

    abstract::The objective of this review is to evaluate the usefulness of oral cobalamin (vitamin B12) treatment in elderly patients. PubMed was systematically searched for English and French articles published from January 1990 to January 2007. Prospective randomized studies (n=3), a systematic review by the Cochrane group (n=1)...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审

    doi:10.2165/0002512-200825110-00003

    authors: Andrès E,Vogel T,Federici L,Zimmer J,Kaltenbach G

    更新日期:2008-01-01 00:00:00

  • Multiple sclerosis in the elderly patient.

    abstract::Multiple sclerosis (MS) is an acquired inflammatory demyelinating disease of the CNS that is typically diagnosed in the second or third decade of life. It is generally believed that over the last few decades the life expectancy of patients with adult onset MS (AOMS) has approached that of the general population as a r...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审

    doi:10.2165/11532120-000000000-00000

    authors: Awad A,Stüve O

    更新日期:2010-04-01 00:00:00

  • Getting better, getting well: understanding and managing partial and non-response to pharmacological treatment of non-psychotic major depression in old age.

    abstract::In general, the pharmacological treatment of non-psychotic major depressive disorder in old age is only partially successful, with only approximately 50% of older depressed adults improving with initial antidepressant monotherapy. Many factors may predict a more difficult-to-treat depression, including coexisting anxi...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审

    doi:10.2165/00002512-200724100-00002

    authors: Driscoll HC,Karp JF,Dew MA,Reynolds CF 3rd

    更新日期:2007-01-01 00:00:00

  • Potentially Inappropriate Antihypertensive Prescriptions to Elderly Patients: Results of a Prospective, Observational Study.

    abstract:INTRODUCTION:Previous studies of antihypertensive treatment of older patients have focused on blood pressure control, cardiovascular risk or adherence, whereas data on inappropriate antihypertensive prescriptions to older patients are scarce. OBJECTIVES:The aim of the study was to assess inappropriate antihypertensive...

    journal_title:Drugs & aging

    pub_type: 杂志文章,多中心研究

    doi:10.1007/s40266-017-0452-z

    authors: Márquez PHP,Torres OH,San-José A,Vidal X,Agustí A,Formiga F,López-Soto A,Ramírez-Duque N,Fernández-Moyano A,Garcia-Moreno J,Arroyo JA,Ruiz D,Potentially Inappropriate Prescription in Older Patients in Spain (PIPOPS) Investigators

    更新日期:2017-06-01 00:00:00

  • Xerostomia and hyposalivation: causes, consequences and treatment in the elderly.

    abstract::Xerostomia and salivary gland hypofunction (SGH) are prevalent in elderly populations, causing much discomfort and even difficulties in eating. SGH also increases the occurrence and severity of oral diseases and makes the patient susceptible to candidiasis. The principal causes of SGH and xerostomia are systemic disea...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审

    doi:10.2165/00002512-199915020-00004

    authors: Närhi TO,Meurman JH,Ainamo A

    更新日期:1999-08-01 00:00:00

  • Early detection of Parkinson's disease. Implications for treatment.

    abstract::Parkinson's disease (PD) is the second most common neurodegenerative disorder worldwide and is characterised by cardinal clinical features and specific pathological findings. It is possible to detect PD early on in the course of the disease, and certain laboratory studies may identify preclinical stages. Based on this...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审

    doi:10.2165/00002512-199609030-00002

    authors: Di Paola R,Uitti RJ

    更新日期:1996-09-01 00:00:00

  • CYP2D6 Metabolism in Frail Elderly Compared to Non-Frail Elderly: A Pilot Feasibility Study.

    abstract:BACKGROUND:Frailty is a clinical phenotype that is associated with adverse health outcomes. Since frail patients may be more prone for adverse drug events and about 15-20 % of commonly prescribed drugs are metabolized by CYP2D6, we hypothesized that CYP2D6 metabolism is decreased in frail patients compared with healthy...

    journal_title:Drugs & aging

    pub_type: 杂志文章

    doi:10.1007/s40266-015-0319-0

    authors: Opdam FL,Modak AS,Mooijaart SP,Louwerens M,de Waal MW,Gelderblom H,Guchelaar HJ

    更新日期:2015-12-01 00:00:00

  • Late-Onset and Elderly Psoriatic Arthritis: Clinical Aspects and Management.

    abstract::Psoriatic arthritis (PsA) can start in subjects aged over 60 years, defined as late-onset PsA. In late-onset PsA, the weight of family history and genetic background appears less significant when compared with younger onset PsA, whereas obesity and smoking have been suggested as potential risk factors. In patients wit...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审

    doi:10.1007/s40266-019-00688-3

    authors: Caso F,Tasso M,Chimenti MS,Navarini L,Perricone C,Girolimetto N,Peluso R,Del Puente A,Afeltra A,Perricone R,Punzi L,Scarpa R,Costa L

    更新日期:2019-10-01 00:00:00

  • Spasticity after stroke. Epidemiology and optimal treatment.

    abstract::Spasticity following stroke reflects a spectrum of clinical problems including increased muscle tone, abnormal limb posture, excessive contraction of antagonist muscles and hyperactive cutaneous and tendon reflexes. The prevalence of stroke-related disability in stroke survivors is high, and spasticity may be a signif...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审

    doi:10.2165/00002512-199609050-00004

    authors: O'Brien CF,Seeberger LC,Smith DB

    更新日期:1996-11-01 00:00:00

  • Safety and efficacy of once-daily gastroretentive gabapentin in patients with postherpetic neuralgia aged 75 years and over.

    abstract:BACKGROUND:Treatment of postherpetic neuralgia (PHN) is more complicated in elderly patients, and multiple daily dosing, complex titration, and high incidences of adverse events can be limiting for many pharmacological treatment options. OBJECTIVE:The aim of this study was to determine whether the efficacy and tolerab...

    journal_title:Drugs & aging

    pub_type: 杂志文章

    doi:10.1007/s40266-013-0126-4

    authors: Gupta A,Li S

    更新日期:2013-12-01 00:00:00

  • Disease-modifying antirheumatic drugs. Potential effects in older patients.

    abstract::Disease-modifying antirheumatic drugs (DMARDs) are frequently used in rheumatoid arthritis. A number of physiological changes occur in the elderly which may modify the use of these medications. The most commonly used DMARDs are antimalarial drugs (particularly hydroxychloroquine), sulfasalazine and methotrexate. The p...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审

    doi:10.2165/00002512-199507060-00003

    authors: Gardner G,Furst DE

    更新日期:1995-12-01 00:00:00

  • Treating asthma in the older patient: is there a place for leukotriene modifiers?

    abstract::Asthma is a common airway disease found in people of all ages, although most studies of asthma therapies are focused on adolescent and young adults. Little information exists on the use of asthma therapeutics in the older patient (>65 years of age). The newest therapeutic class to be released in the US for the treatme...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审

    doi:10.2165/00002512-200623060-00002

    authors: Grayson MH,Korenblat PE

    更新日期:2006-01-01 00:00:00

  • Diagnostic and pharmacological approaches in Alzheimer's disease.

    abstract::Alzheimer's disease is a chronic progressive disease affecting higher intellectual functioning. The clinical diagnosis is made when the onset of illness is insidious, the course slowly progressive and all the treatable causes of dementia have been ruled out. The use of more stringent criteria has improved clinical dia...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审

    doi:10.2165/00002512-199101020-00006

    authors: Hermann C,Stern RG,Losonzcy MF,Jaff S,Davidson M

    更新日期:1991-03-01 00:00:00

  • High prevalence of medication non-adherence in a sample of community-dwelling older adults with adult protective services-validated self-neglect.

    abstract:BACKGROUND:Medication non-adherence can exacerbate disease severity, leading to impairments that interfere with self-care activities in older adults, and, ultimately, death. Elder self-neglect is the most common report to Adult Protective Services (APS) across the USA and is a significant risk factor for early mortalit...

    journal_title:Drugs & aging

    pub_type: 杂志文章

    doi:10.1007/s40266-012-0007-2

    authors: Turner A,Hochschild A,Burnett J,Zulfiqar A,Dyer CB

    更新日期:2012-09-01 00:00:00

  • Inflammatory bowel disease in the elderly.

    abstract::Although inflammatory bowel disease (IBD) is generally considered a disease of young adults, it can occur in elderly individuals. The clinical features and treatment considerations in older patients are similar to those in younger patients, with some notable exceptions, which are reviewed in this article. Consideratio...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审

    doi:10.2165/11537340-000000000-00000

    authors: Hussain SW,Pardi DS

    更新日期:2010-08-01 00:00:00

  • The role of nitric oxide in neurodegeneration. Potential for pharmacological intervention.

    abstract::Nitric oxide (NO) is involved in important physiological functions of the CNS, including neurotransmission, memory and synaptic plasticity. Depending on the redox state of NO, it can act as a neurotoxin or it can have a neuroprotective action. Data suggest that NO may have a role in the pathogenesis of neurodegenerati...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审

    doi:10.2165/00002512-199812040-00001

    authors: Molina JA,Jiménez-Jiménez FJ,Ortí-Pareja M,Navarro JA

    更新日期:1998-04-01 00:00:00