Polypharmacy and Potentially Inappropriate Medications at the End of Life: Prevalence,Predictors,and Deprescribing Implications From a STOPPFrail Study

Abstract

Objectives

Polypharmacy and potentially inappropriate medications (PIMs) are common among end-of-life older adults and may cause harm while offering limited benefit. Evidence from Asia remains scarce. This study aimed to determine the prevalence of polypharmacy and PIMs, and to identify associated factors using the Screening Tool of Older Persons’ Prescriptions in Frail adults with limited life expectancy (STOPPFrail) version 2.

Methods

We conducted a retrospective cross-sectional chart review of patients aged ≥60 years referred to the Palliative Care Unit at Thammasat University Hospital, Thailand, between January and December 2021. Polypharmacy was defined as the concurrent use of ≥5 medications. PIMs were identified using STOPPFrail version 2. Logistic regression was applied to examine associations between demographic and clinical variables and polypharmacy or PIM use.

Results

Of 384 patients screened, 244 met inclusion criteria. The mean age was 75.7 years, and 51.2% were male. Polypharmacy was observed in 82.8%, while 93.7% received at least one PIM. Factors significantly associated with polypharmacy included hospital stay ≥11 days (OR 2.43, 95% CI 1.12-5.29, P = .025) and a higher number of symptoms (OR 1.61, 95% CI 1.00-2.58, P = .048). PIM use was associated with a Palliative Performance Scale of 30% (OR 6.23, 95% CI 1.13-34.47, P = .036) and polypharmacy (OR 17.95, 95% CI 4.42-72.99, P < .001).

Conclusions

Polypharmacy and PIMs are highly prevalent among end-of-life older adults in Thailand. These results highlight the need for systematic medication review and deprescribing strategies, supported by multidisciplinary teams, to reduce medication burden and improve patient-centered palliative care.

Keywords

polypharmacy potentially inappropriate medications end-of-life palliative older adults deprescribing

Get full access to this article

View all access options for this article.

References

UNESCAP . Social Development: Ageing Societies. New York: UN; 2021. [cited 2022 Jul 16]. Available from:. https://www.unescap.org/our-work/social-development/ageing-societies

Department of Older Persons . Situation of the Thai Older Persons 2023. Bangkok: Department of Older Persons, Ministry of Social Development and Human Security; 2024. Available from:. https://www.dop.go.th/download/statistics/th1738230377-2563_1.pdf

Glinskaya

Walker

Wanniarachchi

. Caring for Thailand’s aging population. 2021.

United Nations, Department of Economic and Social Affairs, Population Division . World Population Ageing 2019: Highlights. New York: United Nations; 2020.

Morin

Vetrano

Rizzuto

Calderón-Larrañaga

Fastbom

Johnell

. Choosing wisely? Measuring the burden of medications in older adults near the end of life: nationwide, longitudinal cohort study. Am J Med. 2017;130(8):927-936. doi:10.1016/j.amjmed.2017.02.028

Pongboriboon

. The elderly situation in Thailand: health’s problems and needs. 2020;12(2): 46-58.

Bonanno

Figueiredo

Mimoso

, et al. Polypharmacy prevalence among older adults based on the survey of health, ageing and retirement in Europe: an update. J Clin Med. 2025;14(4):1330. doi:10.1016/j.archger.2018.06.018

Sera

Uritsky

. Pharmacokinetic and pharmacodynamic changes in older adults and implications for palliative care. Prog Palliat Care. 2016;24(5):255-261. doi:10.2165/00003088-199835010-00004

Hardy

Hilmer

. Deprescribing in the last year of life. J Pharm Pract Res. 2011;41(2):146-151.

10.

McNeil

Kamal

Kutner

Ritchie

Abernethy

. The burden of polypharmacy in patients near the end of life. J Pain Symptom Manag. 2016;51(2):178-183. doi:10.1016/j.jpainsymman.2015.09.003

11.

Paque

Elseviers

Vander Stichele

, et al. Balancing medication use in nursing home residents with life-limiting disease. Eur J Clin Pharmacol. 2019;75(7):969-977. doi:10.1007/s00228-019-02649-6

12.

Pruskowski

Springer

Thorpe

Klein-Fedyshin

Handler

. Does deprescribing improve quality of life? A systematic review of the literature. Drugs Aging. 2019;36(12):1097-1110. doi:10.1007/s40266-019-00717-1

13.

Stinson

Gurevitz

Carrigan

. Deprescribing at the end of life in older patients. Journal of the American Academy of PAs. 2019;32(7):20-24. doi:10.1097/01.JAA.0000558316.40245.ca

14.

Todd

Husband

Andrew

Pearson

S-A

Lindsey

Holmes

. Inappropriate prescribing of preventative medication in patients with life-limiting illness: a systematic review. BMJ Support Palliat Care. 2017;7(2):113-121. doi:10.1136/bmjspcare-2015-000941

15.

Lindsay

Dooley

Martin

Fay

Kearney

Barras

. Reducing potentially inappropriate medications in palliative cancer patients: evidence to support deprescribing approaches. Support Care Cancer. 2014;22(4):1113-1119. doi:10.1007/s00520-013-2098-7

16.

Lindsay

Dooley

Martin

, et al. The development and evaluation of an oncological palliative care deprescribing guideline: the ‘OncPal deprescribing guideline. Support Care Cancer. 2015;23(1):71-78. doi:10.1007/s00520-014-2322-0

17.

Siraprapasiri

. Introduction. In: Palliative and End-of-Life Care Handbook (for Healthcare Professionals) [Internet], 1. Bangkok: War Veterans Organization of Thailand Under Royal Patronage; 2020. [25-32 (in Thai)]. Available from:. https://shorturl.at/ffSqx

18.

Schenker

Park

Jeong

, et al. Associations between polypharmacy, symptom burden, and quality of life in patients with advanced, life-limiting illness. J Gen Intern Med. 2019;34:559-566. doi:10.1007/s11606-019-04837-7

19.

Peralta

Castel-Branco

Reis-Pina

Figueiredo

Dourado

. Prescription trends at the end of life in a palliative care unit: observational study. BMC Palliat Care. 2022;21(1):65. doi:10.1186/s12904-022-00954-z

20.

Kierner

Weixler

Masel

Gartner

Watzke

. Polypharmacy in the terminal stage of cancer. Support Care Cancer. 2016;24(5):2067-2074. doi:10.1007/s00520-015-3007-z

21.

Gardner

. Deprescribing in end-of-life care. Journal of Prescribing Practice. 2019;1(11):540-543. doi:10.12968/bjcn.2019.24.10.474

22.

Harris

. Safe and effective prescribing for symptom management in palliative care. Br J Hosp Med. 2019;80(12):C184-C189. doi:10.12968/hmed.2019.80.12.C184

23.

Van Lancker

Velghe

Van Hecke

, et al. Prevalence of symptoms in older cancer patients receiving palliative care: a systematic review and meta-analysis. J Pain Symptom Manag. 2014;47(1):90-104. doi:10.1016/j.jpainsymman.2013.02.016

24.

Bruera

Kuehn

Miller

Selmser

Macmillan

. The edmonton symptom assessment system (ESAS): a simple method for the assessment of palliative care patients. J Palliat Care. 1991;7(2):6-9.

25.

Curtin

O’mahony

Gallagher

. Drug consumption and futile medication prescribing in the last year of life: an observational study. Age Ageing. 2018;47(5):749-753. doi:10.1093/ageing/afy054

26.

Curtin

Jennings

Daunt

, et al. Deprescribing in older people approaching end of life: a randomized controlled trial using STOPPFrail criteria. J Am Geriatr Soc. 2020;68(4):762-769. doi:10.1111/jgs.16278

27.

Chae

H-W

Kim

Suh

, et al. Prevalence of potentially inappropriate medications based on the STOPPFrail criteria in frail older patients with limited life expectancy: a cross-sectional study. BMC Geriatr. 2022;22(1):1-9. doi:10.1186/s12877-022-03067-7

28.

Kutner

Blatchford

Taylor

Jr , et al. Safety and benefit of discontinuing statin therapy in the setting of advanced, life-limiting illness: a randomized clinical trial. JAMA Intern Med. 2015;175(5):691-700. doi:10.1001/jamainternmed.2015.0289

29.

Gyawali

Fass

. Management of gastroesophageal reflux disease. Gastroenterology. 2018;154(2):302-318. doi:10.1053/j.gastro.2017.07.049

30.

Singh

Kothari

. Use of proton pump inhibitors with dexamethasone in patients with COVID-19 pneumonia: contributions to long-term polypharmacy. Cureus. 2022;14(5):e24661. doi:10.7759/cureus.24661

31.

Sevilla-Sanchez

Molist-Brunet

Espaulella-Panicot

, et al. Potentially inappropriate medication in palliative care patients according to STOPP-Frail criteria. Eur Geriatr Med. 2018;9(4):543-550. doi:10.1007/s41999-018-0073-z

32.

Ham

Geijteman

Aarts

, et al. Use of potentially inappropriate medication in older patients with lung cancer at the end of life. J Geriatr Oncol. 2022;13(1):53-59. doi:10.1016/j.jgo.2021.07.009

33.

Thompson

. Deprescribing in palliative care. Clin Med. 2019;19(4):311-314. doi:10.7861/clinmedicine.19-4-311

34.

Kirci

Cubukcu

Bahsi

Yurt

Kirci

. Examining potentially inappropriate medication use among elderly individuals in palliative care: a comprehensive study. Heliyon. 2024;10(10):e30635. doi:10.1016/j.heliyon.2024.e30635

35.

Masumoto

Hosoi

Nakamura

Hamano

. Polypharmacy and potentially inappropriate medications in patients with advanced cancer: prevalence and associated factors at the end of life. J Palliat Med. 2024;27(6):749-755. doi:10.1089/jpm.2023.0520

36.

Hedman

Frisk

Björkhem-Bergman

. Deprescribing in palliative cancer care. Life. 2022;12(5):613. doi:10.3390/life12050613