Throughout our lives, most of us have been prescribed numerous medications from our healthcare providers. Some of those medications are used to treat an acute, or self-limiting, illness or issue. Others are aimed to control and treat long-term conditions, such as high blood pressure, heart disease or diabetes. However, there comes a time when we, as providers and consumers of healthcare, must make informed decisions about which medications should be used at certain times of our lives. This is when the process of deprescribing is employed. Deprescribing is the systematic process of identifying and discontinuing medications when existing or potential harms outweigh existing or potential benefits.
This process should be performed within the context of the patient’s care goals. Other factors that should be considered include the current level of functioning, life expectancy, values and preferences. The ultimate goal is to reduce polypharmacy and medication burden, all while improving patient outcomes. The process is designed to be proactive, thus preventing an adverse medication event or adverse patient outcome before it occurs.
Understanding Deprescribing in Transitions of Care
Deprescribing can occur at any encounter with a healthcare provider; however, transitions of care are some of the most important times to do a thorough medication assessment, such as a hospital discharge or a hospice admission. There are several patient characteristics to consider that should also trigger a medication review.
- Patients that are frail or demented,
- Those with limited life expectancy,
- Patients with multiple medical problems,
- Those patients seeing multiple medical providers, and
- Those with a long list of medications (polypharmacy)
When reviewing a medication list, healthcare providers should focus on reducing medication burden, eliminating medications with no clear indication for use or those with a preventive indication in an individual with a life-limiting illness, and remove medications with known or possible adverse side effects. Patient nonadherence to a medication is also a strong reason to discontinue in the appropriate setting.
We Understand Patient and Family’s Resistance.
Consider Our Suggestions to Help Ease Your Fear!
Patient and/or their family often have resistance to deprescribing suggestions. However, here is what we know. As patients, we often have a psychological attachment to our medications, and we can certainly feel fearful at the thought of stopping long-term medications. Thus, it is vital for healthcare providers to explain their reasoning for suggesting medication changes. The hospice patient population is a demographic where deprescribing is crucial to ensure patient care goals are met.
- As an individual approaches the end of his/her life, changes in the body and mind inevitably occur.
- Appetite decreases, and weight declines.
- Cognition wanes, and activity level decreases.
- Organ dysfunction often occurs, primarily in the liver and kidneys which are key metabolizers of medications.
- Swallowing ability is often impaired in the last few weeks of life as well.
Patients and their families are often unaware of these current or future changes, and healthcare providers must ensure education is targeted for each patient as an individual. Medications do not change, but the body’s ability to utilize them does. In turn, if changes are not made it increases the risk of adverse medication effects. Overall, the goal of hospice care is pain and symptom control. We customize a plan of care specific to each patient’s wants and needs. Hospice embodies a transition of mindset from preventing and curing diseases to palliating symptoms. Medication use should follow along.
Learn more about the specific classes of medications that are frequently deprescribed in the hospice population. Join us in July and August for more specific articles with further education. As always, we are honored to partner with you, your healthcare provider and our community.
Call Hospice of Southern Illinois to learn more about end-of-life care and hospice services, 800-233-1708. Request a chat.