Recommendations

The Society of Hospital Pharmacists of Australia

1.
Don’t initiate and continue medicines for primary prevention in individuals who have a limited life expectancy.

Frail, elderly patients are more susceptible to the adverse effects of medicines. There is limited evidence to support the use of many medicines in elderly patients as they are typically excluded from clinical trials. One study has estimated the cost to the PBS of potentially inappropriate medication in older patients is between $240 and $450 million each year.

The use of medicines used to prevent a condition, or disease, or those with a long ‘time to benefit’ profile may not be consistent with the life expectancy of the patient and their goals of care.

The proactive de-prescribing of medicines that no longer provide a benefit to the patient is integral to end-of-life care and advance care planning. Patients or their carer, or designated guardian, should be involved in the decision to review treatment and the ongoing need for each medicine.

Supporting evidence
  • Hardy JE, Hilmer SN. Deprescribing in the last year of life. J Pharm Pract Res 2011; 41(2):146-51.
  • Elliott RA, Stehlik P. Identifying inappropriate prescribing for older people. J Pharm Pract Res 2013;43(4):312-9.
  • Scott IA, Le Couteur DG. Physicians need to take the lead in deprescribing. Intern Med J 2015;45(3):352-6.
  • Scott IA, Hilmer SN, Reeve E, Potter K, Le Couteur D, Rigby D et al. Reducing inappropriate polypharmacy. JAMA Internal Medicine 2015;175(5):827-34.