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Individualising Life Expectancy Is Necessary for Optimal Prescribing.

Vije Kumar Rajput1,2, Jack Dowie2,3, Mette Kjer Kaltoft3

  • 1Stonydelph Health Centre, Tamworth, UK.

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|September 8, 2022
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Summary

Addressing patient life expectancy (LE) can reduce medication overprescribing. Probabilistic LE forecasting aids personalized treatment decisions and informed consent, especially for older patients with multiple conditions.

Keywords:
Life expectancyall-cause mortalitydecision supportindividualisationintuition-analysisovertreatmentpersonalisationundertreatment

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Area of Science:

  • Geriatrics
  • Clinical Pharmacology
  • Health Economics

Background:

  • Overprescribing and under-deprescribing are significant issues in patient care.
  • Failure to consider individual life expectancy (LE) contributes to suboptimal medication management.
  • The COVID-19 pandemic has increased focus on mortality and its clinical relevance.

Purpose of the Study:

  • To advocate for the integration of life expectancy (LE) into prescribing decisions.
  • To explore methods for estimating individual LE in clinical practice.
  • To reduce medication overprescribing through personalized treatment planning.

Main Methods:

  • Review of current prescribing practices and their limitations.
  • Discussion of probabilistic forecasting for life expectancy estimation.
  • Focus on application in older patients with multiple comorbidities and polypharmacy.

Main Results:

  • Explicitly incorporating LE can lead to more individualized prescribing.
  • Probabilistic LE forecasting is essential for optimal intervention selection.
  • This approach supports the 'reasonable patient' standard for informed consent.

Conclusions:

  • Integrating life expectancy into prescribing decisions is crucial for personalized medicine.
  • This strategy has the potential to mitigate medication overprescribing, particularly in complex patient populations.
  • Enhanced discussion of mortality in clinical settings is recommended.