A Patient's Last Wish at the End-of-Life

Patients who have transitioned to end-of-life (EOL) care are at an increased risk for polypharmacy as they face new symptoms requiring palliative-care medications.

The patient was a 96-year-old, 6' 2", 125-pound male patient who was brought into the outpatient geriatric practice by his daughter, with whom he had been living all his life. The patient had no pain, but severe dysphagia. Both daughter and patient were fully aware that death was imminent, as the patient had lost 60 pounds in the past three to four months because of gastrointestinal cancer. The daughter asked if she could stop any of his medications, which she had been struggling to provide because of his dysphagia; Her bed-bound father was anorectic; at that point the geriatrician called for a pharmacy consult, specifically to address the issue of unnecessary medications.

There is little evidence or guidance in reducing or discontinuing medications for chronic illnesses during EOL care. While it is understandable that the number of symptom-relief medications will increase, patient comfort can be helped by reducing maintenance medications that have little to no short-term benefit.

As EOL approaches, a patient's last wishes must be respected, including timely changes to his or her medication regimen. Pharmacists are an essential asset to the geriatric interdisciplinary team, as they can provide extensive medication counseling.