Discontinuation of medications at the end of life. A population study in Belgium, based on linked administrative databases

AIM: To examine Potentially Inappropriate Medication (PIM) use in relation to time before death, to explore if PIMs are discontinued at the end of life, and the factors associated with this discontinuation.

METHODS: We conducted a retrospective register-based mortality cohort study of all deceased in 2012 in Belgium, aged at least 75 years at time of death (n=74368), using linked administrative databases. We used STOPPFrail to identify PIMs received during the period of twelve to six months before death (P1) and the last four months (P2) of life.

RESULTS: Median age was 86 (IQR:81-90) at time of death, 57% female, 38% was living in a nursing home, and 16% was admitted to hospital two years to four months before death. Overall, PIM use was high, and increased towards death for all PIMs. At least one PIM was discontinued during P2 for one in five (20%) of the population, and 49% had no discontinuation. Being hospitalized in the period before the last four months of life, living in a nursing home, female gender, and a higher number of medications used during P1 were associated with discontinuation of PIMs (respective aOR(95%CI): 2.89(2.73-3.06), 1.29(1.23-1.36), 1.26(1.20-1.32), 1.17(1.16-1.17)).

CONCLUSION: Initial PIM use was high and increased towards death. Only in one in five PIM users discontinuation was observed. More guidance for discontinuation of PIMs is needed: practical, evidence-based deprescribing guidelines and implementation plans, training for prescribers and a better consensus on what inappropriate medication is.