Guideline for Medication Management of Distressing Symptoms in Older Patients Receiving End-of-Life Palliative Care

Older patients receiving end-of-life palliative care often present with multiple geriatric syndromes, frailty, and comorbid symptom burden, resulting in a high risk of medication-related harm. This guideline focuses on pharmacological management of distressing symptoms in older patients receiving end-of-life or hospice-oriented palliative care, rather than disease-modifying treatment of chronic conditions. The guideline was developed in accordance with the standards of the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) system and the Reporting Items for Practice Guidelines in Healthcare (RIGHT). It addresses 15 common distressing symptoms and provides 65 recommendations. On the basis of the best available evidence, patient values, feasibility, and expert consensus, the panel formulated recommendations intended to support safe, rational, individualized, and goal-concordant medication use in older patients at the end of life. This guideline aims to identify and recommend appropriate pharmacological treatments for common and refractory symptoms in older palliative care patients and to provide guidance for healthcare professionals on safe, rational, and standardized medication use.