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Drugs & Aging

, Volume 27, Issue 6, pp 435–449 | Cite as

Withholding, Discontinuing and Withdrawing Medications in Dementia Patients at the End of Life

A Neglected Problem in the Disadvantaged Dying?
  • Carole ParsonsEmail author
  • Carmel M. Hughes
  • A. Peter Passmore
  • Kate L. Lapane
Current Opinion

Abstract

Recent years have seen a growing recognition that dementia is a terminal illness and that patients with advanced dementia nearing the end of life do not currently receive adequate palliative care. However, research into palliative care for these patients has thus far been limited. Furthermore, there has been little discussion in the literature regarding medication use in patients with advanced dementia who are nearing the end of life, and discontinuation of medication has not been well studied despite its potential to reduce the burden on the patient and to improve quality of life. There is limited, and sometimes contradictory, evidence available in the literature to guide evidence-based discontinuation of drugs such as acetylcholinesterase inhibitors, antipsychotic agents, HMG-CoA reductase inhibitors (statins), antibacterials, antihypertensives, antihyperglycaemic drugs and anticoagulants. Furthermore, end-of-life care of patients with advanced dementia may be complicated by difficulties in accurately estimating life expectancy, ethical considerations regarding withholding or withdrawing treatment, and the wishes of the patient and/or their family. Significant research must be undertaken in the area of medication discontinuation in patients with advanced dementia nearing the end of life to determine how physicians currently decide whether medications should be discontinued, and also to develop the evidence base and provide guidance on systematic medication discontinuation.

Keywords

Dementia Palliative Care Memantine Nursing Home Resident Dementia Patient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgements

No sources of funding were used to assist in the preparation of this article. Carole Parsons, Carmel Hughes and Kate Lapane have no conflicts of interest that are directly relevant to the content of this article. Professor Passmore has received grants, honoraria and consultancy fees from Pfizer, Eisai, Shire, Janssen and Lundbeck.

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Copyright information

© Adis Data Information BV 2010

Authors and Affiliations

  • Carole Parsons
    • 1
    Email author
  • Carmel M. Hughes
    • 1
  • A. Peter Passmore
    • 2
  • Kate L. Lapane
    • 3
  1. 1.Clinical and Practice Research Group, School of PharmacyQueen’s University BelfastBelfastNorthern Ireland
  2. 2.Department of Geriatric Medicine, School of Medicine, Dentistry and Biomedical SciencesQueen’s University BelfastBelfastNorthern Ireland
  3. 3.Department of Epidemiology and Community HealthVirginia Commonwealth UniversityRichmondUSA

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