Polypharmacy in palliative care-COPD and multimorbidity : A case report

Area of Science:

• Geriatrics
• Pulmonology
• Clinical Pharmacy

Background:

• Managing polypharmacy in elderly patients with advanced chronic obstructive pulmonary disease (COPD), multimorbidity, and frailty presents significant challenges.
• Regular medication reviews are crucial but often insufficient to achieve substantial drug reduction in complex cases.

Observation:

• An 80-year-old frail patient with advanced COPD and multiple comorbidities experienced difficulties in medication reduction.
• The patient suffered from several episodes of delirium, potentially linked to the complex medication regimen.
• Managing cardiovascular, endocrinologic, orthopaedic, neurologic, psychiatric, and pulmonary conditions complicated deprescribing efforts.

Findings:

• Despite critical re-evaluation, significant medication reduction was not achieved until the patient's terminal phase.
• Probable drug-drug interactions and adverse side effects were frequently observed throughout the treatment course.
• The case illustrates the complexity of deprescribing in frail, elderly patients with extensive comorbidities.

Implications:

• This case highlights the clinical dilemma of medication management in frail patients with advanced COPD and multimorbidity.
• Strategies for effective deprescribing in this vulnerable population require further investigation.
• Addressing polypharmacy is essential to prevent adverse drug events and improve patient outcomes in geriatric care.