Understanding why potentially inappropriate medications are continued at the end of life

A recent interview study has uncovered factors that may contribute to the use of potentially inappropriate medications (PIMs) at the end of life.

Limited awareness may contribute to physicians' practice of not discussing the discontinuation of PIMs at the end of life. Physicians also mentioned concerns about the reaction of individuals and relatives, although individuals with a limited life expectancy and their relatives might be more willing to discontinue PIMs than their attending physicians believe.

In rare cases in which physicians discuss the discontinuation of PIMs, they tend to focus on the uselessness of their continuation, but emphasizing the positive aspects of stopping PIMs, such as reducing the burden of taking pills, may be a more fruitful approach.

"Although important, reconsideration of the administration of medications in the final stages of life, especially those with a focus on the prevention and treatment of illnesses, happens too little," said Dr. Eric Geijteman, lead author of the Journal of the American Geriatrics Society article. "Physicians seem to be a bit scared to discontinue drugs in these stages. Patients and their relatives, however, seem to be open to stop inappropriate drugs."