Women With Highest Risk of Stroke

Women are at higher risk of stroke, and have a higher mortality rate.  Be aware if you are in this category, be closely monitored, and maintain the habits of a healthy lifestyle.

Women Who Are Most at Risk of Stroke

— Robert Preidt

woman face

THURSDAY, Feb. 8, 2018 (HealthDay News) — Stroke affects more women than men in the United States. And a new study pinpoints stroke risk factors unique to females.

“Many people don’t realize that women suffer stroke more frequently than men, and mortality is much higher among women,” said Dr. Kathryn Rexrode, the study’s corresponding author.

“As women age, they are much more likely to have a stroke as a first manifestation of cardiovascular disease rather than heart attack,” said Rexrode, who is with Brigham and Women’s Hospital in Boston.

The study attempts to better understand susceptibility, she said.

“Why do more women have strokes than men? What factors are contributing and disproportionately increasing women’s risk?” Rexrode said in a hospital news release.

Stroke affects 55,000 more women than men each year in the United States. It’s the leading cause of disability and the third leading cause of death in women, the researchers said in background notes.

Rexrode’s team analyzed the scientific literature and identified several factors that increase stroke risk in women. These include:

  • Menstruation before age 10,
  • Menopause before age 45,
  • Low levels of the hormone dehydroepiandrosterone (DHEAS),
  • Use of birth control pills.

A history of pregnancy complications can also indicate higher stroke risk. These problems include gestational diabetes and high blood pressure during or immediately after pregnancy, the researchers said.

Some of these risk factors are common, and the researchers stressed that few women who have one or more will suffer a stroke. However, they said it’s important for health care providers to be aware of any heightened risk.

“These women should be monitored carefully and they should be aware that they are at higher risk, and motivated to adhere to the healthiest lifestyle behaviors to decrease the risk of hypertension (high blood pressure) and subsequent stroke,” Rexrode said.

The paper was published Feb. 8 in the journal Stroke.

More information

The National Stroke Association has more on women and stroke.

SOURCE: Brigham and Women’s Hospital, news release, Feb. 8, 2018

Collaborating and Advocating for Your Health and Well-Being

Patients and their healthcare providers need a shared language.  There’s a distinction between achieving a strategy, objective, and goal.  For example, a patient-client wanted to use weight-lifting (strategy), to develop her upper body strength (objective), so she could easily pick up her grandchild (goal).


Achieving Your Personal Health Goals: A Patient’s Guide

John Henning Schumann, MD

Dr. James Mold, a family physician and author of Achieving Your Personal Health Goals, says doctors should work with their patients to set mutually agreed-upon goals throughout life.

Many of us make New Year’s resolutions. Few of us realize them. Maybe it would help to reframe how we handle our resolutions by thinking of them as goals instead.

What health goals will you reach for in 2018? And which, if any, will you discuss with your doctor?

A new book, Achieving Your Personal Health Goals, is a patient’s guide for setting life goals and also planning for the inevitable end. It’s a shift from the usual medical framework that looks at health improvement as a set of problems of sickness to be solved.

Family physician and geriatrician James Mold, who wrote the book, has spent more than a quarter-century thinking about how to use goals to improve health care.

Mold is one of only four Oklahomans ever to be inducted into the prestigious National Academy of Medicine. He’s now retired and living in his native North Carolina, so I was pleased to be able connect with him recently in an interview for Public Radio Tulsa’s Medical Monday.

Here are highlights from our conversation, edited for length and clarity.

Forgive me for asking, but isn’t all health care directed by goals?

You would think so. The concept is that people’s own attention to their health should be directed at some sort of goal that makes sense in how they view health.

If you think health involves living as long as possible, or at least living until life no longer seems worthwhile, then you should do things that help you achieve that goal.

Doctors tend to focus on strategies and not goals. The assumption is that if you do the strategies well — that is, if you cure disease and solve all the health problems — that the goals will take care of themselves.

It worked really well when most of the health problems that we saw were infections or injuries. But it doesn’t work as well for other things — particularly things we deal with these days, like diabetes, hypertension, obesity and alcoholism — those things that aren’t easily treatable.

What if someone had diphtheria and we cured it? Isn’t cure the goal?

A goal is something you want to have happen where it doesn’t make any sense to ask why would we want to have that happen.

Curing diphtheria is not really a goal but a strategy — the goal is to keep you alive. And keeping you alive is a goal because it doesn’t make sense to ask why would you want to stay alive.

We tend to view aging as inevitable and disappointing. So by reframing care as goal-directed aging, then getting old is less a problem than a part of life, right?

My mother, before she died, wanted to improve her balance (a strategy), so that she could get rid of the walker (an objective) so that she could go back to gardening (her goal).

It’s really important to be clear about what a goal is, because if you don’t understand what a goal is, then goal-directed care is no different from what we’re doing now.

Your book is written for patients. You make the point that goal-directed care is mutually agreed upon between doctor and patient. It’s the patient’s goal that the doctor can help the patient clarify and achieve, correct?

No, it’s a negotiated settlement, if you will. One of the nice things about goal-directed care is that it puts the doctor and the patient on equal footing so that they both have something to contribute to the discussion. So the patient knows what their values and preferences are, and what they’re able and willing to do, and the doctor knows what is possible to do. If you put that information together, you come up with something that’s reasonable.

I remember a patient vividly in a small town in North Carolina who came in every week to have her blood sugar checked, and it was always out of control. I did everything I could to advise her as to how to get it under control. So I put her in the hospital and her blood sugar came right down to normal. I told her she really didn’t need to come back every week until she did the things I told her to do. It wasn’t’ going to be under control. And she fired me!

I later learned the reason that she came in every week was because it was a social event for her; she knew everybody in the practice. She saw people in the waiting room and got some attention and she felt the only way she could do that was to keep her blood sugar out of control.

I totally misunderstood that. I think it would’ve been a lot clearer if we could have agreed on the goals up front. Whether I could have gotten that goal from her, if she would’ve admitted to that, I don’t know. But at least we would have had an opportunity to figure out what was going on.

What about goals near the end of life?

Since medical school, one of my missions in life is to try to make medical care more humane. I became a family physician because I thought that was the field that was talking the right talk. By the late 1980s it seemed that the revolution had moved to the field of geriatrics, so I became a geriatrician.

As a geriatrician, I was faced with lots of folks who had incurable problems, and who, as they aged, became less and less functional and less able to participate in meaningful life activities.

I worked at a rehab institute that I helped to establish. We worked with occupational, physical and speech therapists, and they were talking about goals. That’s the first I’d ever heard about the term “goal” in medicine, at least in the sense that I think of it now. That got me thinking, “Why don’t we think in terms of goals?”

Doctors didn’t understand why we needed to think that way. Geriatricians sort of got it.

Since 1991 I’ve been trying to convince doctors that this might be a better way to think, with very little success. One of my non-physician colleagues told me to write a book for patients — that they would get it, and perhaps they could demand a change in the health care system.

Important Tips For Home Set-Up To Accommodate Vision Loss

The Braille Institute of America knows every 7 minutes someone in the U.S. loses their sight, often as a part of the aging process.  Here are 10 essential tips for setting up a home, or accommodating a visiting person with limited vision.  It’s information we can all use!




Vision Loss: 10 Vital Tips for Anyone living in or visiting the home

  1. DO NOT MOVE ANYTHING unless you put it back exactly where you found it.  Visually impaired people have it down precisely how far back or far away from something a thing is.  Moving it can cause confusion and frustration as they search by feel for it.
  2. CONTRAST COLORS.  We are used to black on white, like this article, but in fact many visually impaired people see better with light writing on a dark background.
  3. LOTS OF LIGHT.   Open curtains, turn lights on, let the sunshine in!  Low Vision sufferers see better in well lit conditions, allowing a better definition of objects and contrast of color and light.  
  4. BEWARE OF HAZARDS lurking below the knees.  Do a walk around focusing on the area below the knee, are there any obstacles hiding against the baseboards or protruding from the walls?
  5. DOORWAY TO HELL.  Most doorways, especially in modular and mobile homes aren’t wide enough to fit a walker or wheelchair.  Look for door wideners (offset hinges) that can amazingly  expand doorway widths 2 inches.
  6. LOOKING GLASS.  Glasses help even when they don’t make reading better.  Glasses sometimes help with balance, as it keeps focus in a smaller area and allow the brain to adapt.
  7. HAZARDOUS MATERIALS.  Rugs.  Knives in a drawer.  Metal tops from opened cans.  Round objects not in a container.  Animals.  Ice Makers on door of fridge.  Loose Wires.  What else?
  8. MY MARKER, MY FRIEND.  Use a large black marker to make recognizable marks on Medicine tops, cleaners, can tops, anything that has small writing.
  9. TV LISTING.  Seems so simple, doesn’t it?  But if you can’t see the TV you have to listen, and if you can’t see the channel, you can’t go to a program you want to listen to.  Also, make a list of favorite programs in large print with the channel listed next to it.  
  10. LAST BUT NOT LEAST.  Contact your state’s Commission for the Blind.  They provide vision exams, visual aides, and even voice recognition training and software when approved.

Alternative, Integrative, Holistic… Patient Advocates Can Help You Sort Through The Confusion

The term “Alternative Medicine” is frequently used incorrectly. The true definition is ‘any non-conventional intervention that is used INSTEAD OF conventional treatments, NOT in conjunction with them’. This article does a good job of distinguishing and explaining many terms like alternative, complementary, holistic, and integrative. It also discusses several non-conventional modalities- acupuncture, yoga, massage, etc.

What Is Alternative Medicine?

Christine Huang Contributor

Anah McMahon, L. Ac. adjusts one inch seirin acupuncture needles in the muscles around the spine of Mariah VanHorn to relieve lower back pain, Monday, Sept. 24, 2007, at the Pacific College of Oriental Medicine in Chicago. Researchers at Ruhr University Bochum in Bochum, Germany, found that both real and fake acupuncture perform much better than conventional care for low back pain relief.

Acupuncture is an effective form of alternative medicine that has proven to treat over 20 conditions including depression, hypertension and stroke, according to clinical studies conducted by the University of California San Diego Center for Integrative Medicine. (Spencer Green/AP)

If you’ve ever stretched out on a yoga mat or popped a probiotic, you may be part of the growing segment of the U.S. population that uses non-conventional therapies to treat medical problems.

Complementary and alternative medicine, sometimes referred to as CAM, is an umbrella term for a vast array of treatments that fall outside conventional Western approaches. Some have been well-studied and proven to be effective; others have not.

Although labels like “alternative medicine,” “naturopathic medicine” and “integrative medicine” are often casually used (and misused), each term refers to something specific and different.

Here are eight common terms used in non-conventional approaches to medicine and what researchers and practitioners say about them.

According to the National Center for Complementary and Integrative Health, actual alternative medicine is very rare. The organization defines alternative medicine as any non-conventional interventions that are used instead of conventional treatments, not in conjunction with them. Interventions like yoga, acupuncture, herbal remedies and massage therapy may be alternative treatments, but are considered alternative medicine only when they’re used in place of conventional treatments, explained National Center for Complementary and Integrative Health Deputy Director David Shurtleff.

Complementary Health Care

Complementary health care refers to alternative treatments used in conjunction with mainstream treatment.

Using acupuncture in conjunction with standard pharmacological treatment of osteoarthritis of the knee, for instance, is a form of complementary medicine that has been proven to be more effective than the conventional treatment alone.

Shurtleff noted that some non-conventional practices eventually become accepted as part of standard, conventional care. “As the practice becomes more codified, as people start to request it, as evidence starts to become more solid as far as the efficacy…it can become more mainstream,” he said, pointing out how chiropractic care was once considered complementary medicine, but is now part of conventional care for certain people, including veterans.

Integrative Health Care

Integrative health care can be defined in several ways, but “all involve bringing conventional and complementary approaches together in a coordinated way,” according to the National Center for Complementary and Integrative Health.

“Integrative [health care] is a philosophy of how we take care of the patient,” said Melinda Ring, clinical associate professor of medicine at Northwestern Medicine’s Osher Center for Integrative Medicine. “It is an approach that looks holistically at the patient, including all aspects of their lifestyle, their community, their environment, in addition to physical and emotional aspects of their health.” The goal is to seek to address the roots of illness, not just the symptoms.
Natural Health Care Products

Natural health care products are nutritional or dietary supplements, including herbs, that are not vitamins or minerals. The NCCIH reports that the most common natural product used by adults in 2012 was fish oil. Other popular natural products include melatonin, echinacea and probiotics.

Many natural products have not yet been sufficiently studied or scrutinized. According to the NCCIH, more research is being done to determine the efficacy of different supplements.

“Some of the earlier studies were not so well designed,” Ring said. Researchers may not have used the right parts of certain plants or used incorrect dosages. “It’s hard to get conclusive data when these studies are looking at different aspects of things, and not always looking at things the way they’ve been used traditionally.”

Timothy Mitchison, professor of systems biology at Harvard Medical School, said that standardizing herbal medicine so each batch has the same amount of active ingredients is a challenge.

Patients seeking natural products should consult a licensed health-care practitioner before using nutritional or herbal supplements, particularly when using them alongside pharmaceuticals, since interactions can occur.

Mind-Body Approaches

According to the National Institute of Health, mind-body medicine focuses on the way emotional, mental, social, spiritual, experiential and behavioral factors affect physical health.

Mind-body approaches include yoga, tai-chi, chiropractic and osteopathic manipulation, meditation, massage therapy, and relaxation techniques like biofeedback therapy and progressive relaxation..

“In the West, the notion that mind and body were separate began during the Renaissance and Enlightenment eras,” the NIH reports. “Increasing numbers of scientific and technological discoveries furthered this split and led to an emphasis on disease-based models, pathological changes and external cures. The role of mind and belief in health and illness began to re-enter Western health care in the 20th century, led by discoveries about pain control via the placebo effect and effects of stress on health.”

Today, practitioners of Western medicine are becoming increasingly aware of the connection between mind and body. In a story for The New York Times last year, Dr. Dhruv Khullar, a resident physician at Massachusetts General Hospital and Harvard Medical School, described the risks to physical health associated with social isolation, which might have once been dismissed as an exclusively mental experience.

Studies are now underway to determine whether practices like loving-kindness meditation can effectively train the brain to better cope with stress and emotions.


Acupuncture, one of the most widely studied non-conventional treatments, involves stimulating various points in the body with needles.

“Clinically, acupuncture is helpful for people who have symptoms and conditions that are made worse by stress, which is most chronic conditions,” said Mel Hopper Koppelman, an acupuncturist and the director of Evidence Based Acupuncture, in an email. “This is partly to do with its effect on quickly rebalancing the autonomic nervous system as well as its role on the hypothalamus, the part of the brain that regulates hormones and the stress response.”

According to the University of California San Diego Center for Integrative Medicine, clinical studies have shown acupuncture to be effective for over 20 conditions including depression, hypertension and stroke. There is limited, but probable, evidence to support the use of acupuncture for dozens of conditions and diseases from opium and tobacco addiction to Tourette Syndrome.

Helene Langevin, director of the Osher Center for Integrative Medicine at Brigham and Women’s Hospital and Harvard Medical School, said that more research is needed to answer other questions about acupuncture, such as whether the location at which needles are placed makes a significant difference. “If we observe different effects of acupuncture when using different combinations of acupuncture points, it is hard to know whether this relate[s] to aspects of Traditional Chinese Medicine theory (like Yin and Yang), or to different nerves being stimulated at the locations that are being compared,” she said in an email.

Naturopathic Medicine

According to the American Association of Naturopathic Physicians, naturopathy draws on traditional, scientific and empirical evidence. Jaclyn Chasse, the president of AANP, said naturopathic physicians are different from Naturopaths, Chasse warned. “Naturopath is not a protected term,” Chasse said.

Unlike Naturopaths, Naturopathic physicians are licensed as primary care providers in many states and receive four years of training in both Western pharmaceutical medicine and other therapies, including nutrition, herbal medicine, homeopathy, physical medicine like osteopathic manipulation, and counseling.

Chasse said most naturopathic physicians prefer to try non-conventional treatments first because conventional treatments are generally restricted to prescription drugs and surgeries. Naturopathic medicine offers more options, she said. “I think there are a lot more tools in our toolkit.” Contrary to popular belief, she added, naturopaths are not against Western medicine.

Traditional Chinese Medicine

Traditional Chinese medicine incorporates a number of treatments, including acupuncture, herbal medicine, cupping, and moxibustion, which involves burning mugwort to improve the flow of energy, or qi. Other techniques often used include tuina, a form of massage, and guasha, in which the practitioner scrapes a part of the body for therapeutic purposes. Practitioners are certified by the National Certification Commission for Acupuncture and Oriental Medicine or the California Acupuncture Board.

“Chinese medicine is essentially a 2,500-year clinical trial,” said Dr. David Miller, a Chicago-based doctor who is board-certified in pediatrics and traditional Chinese medicine.

When properly practiced, Chinese medicine is “very systematic in its thinking,” Miller explained. Before he began studying Traditional Chinese medicine, Miller said his treatment options for patients were limited to pharmaceuticals, reassurance or referral. “Chinese medicine gave me a whole range of treatments that could be appropriated before moving to more extreme stuff that western medicine has to offer.”


Homeopathy is the practice of treating illnesses based on the “law of similars,” which says that substances known to cause certain symptoms can also be used to used to treat those symptoms when used in extremely small doses, said Ronald Whitmont, president of the American Institute of Homeopathy. A 2005 study suggested homeopathy may be beneficial in the long-term care of patients with chronic illnesses.

Homeopaths use “medicine specifically formulated from natural substances that are usually extremely dilute,” Whitmont said. Medications are “prescribed on an individual basis on the holistic totality of the patient’s personal, physical, and emotional attributes.”

Whitmont explained that for a certain substance to be considered homeopathic medicine, it must not only adhere to the “law of similars,” but also be prepared in a way that’s approved by the Homeopathic Pharmacopeia of the United States.

Clarified on July 12, 2017: This article has been updated to clarify the definition of alternative medicine.

Tags: health, health care, medicine, alternative medicine, supplements, acupuncture, mental health, patients, yoga

How Patient Advocates Can Help You And Your Company

Attention corporations! Consider having a skilled (independent) patient advocate on retainer for employees to use in health crisis. An emergency that puts the employee or a loved one in ICU. A new cancer diagnosis. Medical errors. Dementia care. The list is endless, and paying for this type of short term supportive service is a fabulous employee benefit! It also saves $ for the company. Consider a distressed employee’s “presenteeism”, yet what they’re really needing is expert care and guidance.

Patient Advocacy Is Vital to Our Health Care and Treatment

Tiffany Matthews, Healthcare and Patient Advocate

Healthcare in the U.S. is broken and only getting worse. Here are just a few examples of why:

  • Of the $3 trillion spent on healthcare annually, $1 trillion is wasted;
  • Many doctors are providing too much unnecessary treatment;
  • Providers are paid for quantity of care vs. quality of care;
  • Healthcare costs are through the roof for everyone; and
  • Many patients are not aware of their rights and responsibilities within their healthcare.

Many people settle for the care they get from their healthcare providers when they should not. If you ordered a cheeseburger and got a hamburger, wouldn’t you take it back? Do you use that same tactic in your healthcare? Maybe not. You’re not alone, most don’t.

Have you ever had an experience at a doctor or hospital that was uncomfortable or frustrating? Had errors on your bills? Left a doctor’s appointment feeling puzzled? Many experience this every day. I’m here to tell you that you don’t have to deal with poor treatment.

Advocacy is a patient-centered method that can address many of the ills of America’s healthcare delivery, spending waste and inefficiencies.

Being a social worker for 20 years in many areas of healthcare, I’ve seen plenty happen to people who were uninformed or didn’t know what to say, do, or ask. Many times, negative outcomes were preventable.

What is patient advocacy?

This means championing the cause of meeting a patient’s needs and desires during their healthcare journey. This could mean speaking with doctors on a patient’s behalf, facilitating communication between healthcare providers, supporting a patient’s end-of-life wishes, correcting an erroneous bill, helping with insurance claims and so many other things.

Advocates also have focuses such as billing, insurance claims and appeals, specific diseases (cancer, Alzheimer’s, stroke), or getting and keeping good care (like me). There are professionals such as hospital advocates, patient navigators and nurse navigators in healthcare facilities to assist patients with their needs while they are in the hospital.

If you hire a private advocate (one with no corporate/non-profit interests) and pay them directly, their job is to go to the mat for your best interests. If you want to know where the loyalty of any advocate is, find out where their paycheck comes from, and you will have your answer. It’s not always with the patient, unfortunately.

Insurance does not cover advocacy (so private advocates must be paid out-of-pocket), as the government has not regulated our profession. Anyone can say they are an advocate because of this, even my sixth-grader, no matter what their level of experience is. Make sure to check their education, skills and experience before hiring them. Ensure that they are the right fit for your specific needs.

In advocacy, intelligence is not a substitute for experience. Many very sharp people have called on my services because they didn’t know how to handle their healthcare situations, some after making matters worse. They alienated the healthcare providers or they were labeled as “troublemakers.” Communication shuts down between families and providers – which is an awful scenario that does not help the patient’s interests. Advocates can assist you in a situation such as this, and many others depending on their specialty.

Healthcare is a business and you are a consumer. Further, you are responsible for your own healthcare. Patients have to take care of themselves and yield to a provider’s orders, as they are the experts on healthcare. Yet, patients have the right to question any medication, test or procedure proposed to them. Patients must do their part to have good health, as they are the experts on themselves. One cannot drink and smoke heavily and expect a miracle cure for their body after abusing it.

Healthcare spending can decrease once patients learn to use the healthcare system correctly, and a good private advocate can show you how to do that while saving you time, money and frustration.

Not only individuals and families can benefit, but corporations and non-profits can save by enlisting an advocate’s services. It will show their employees (especially those that are caregivers or have chronic illnesses) that there is a more efficient way to experience healthcare treatment, and possibly solve problems which can increase productivity!

The benefits of hiring an advocate can be priceless. Let one assist you in handling the business of healthcare, while you concentrate on the most important role – being a patient.

Pharmacists Speak Out About Too Many Meds at End of Life

Excellent article that addresses what I frequently encounter as an RN Patient Advocate. Key points are to talk to patients about their medication goals, assess medication appropriateness on a regular basis, engage pharmacists to do comprehensive medication reviews, and consider the appropriateness of “deprescibing”, with the communication skills needed to address all of these issues.

Too Many Drugs Too Close to the End?

Older adults often receive drugs that can be of questionable benefit during their last months of life, according to a large study that looked at the end-of-life medications prescribed across an entire nation.

Clinical guidelines that support health care providers when they face the decision to continue or discontinue medications near the end of life are sorely needed, the researchers said (Am J Med 2017 Apr 25. [Epub ahead of print]).

Among older adults, polypharmacy has become commonplace. In high-income countries, an estimated 25% to 40% of those aged 65 years or older are prescribed at least five medications (Lancet 2012;380[9836]:37-43). This polypharmacy can lead to drug–drug interactions and serious adverse effects, according to lead author Lucas Morin, MS, of the Aging Research Center at Karolinska Institutet, in Stockholm.

The researchers identified more than 500,000 adults older than 65 years of age who died in Sweden between 2007 and 2013, and reconstructed their drug prescription history for each of the last 12 months of life through the Swedish Prescribed Drug Register. The characteristics of study participants at time of death were assessed through record linkage with the National Patient Register, the Social Services Register and the Swedish Education Register. This investigation did not consider over-the-counter medications.

They found that patients received more medications as death approached. The proportion of older adults exposed to at least 10 different prescription drugs rose from 30% to 47% over the course of the last year before death. Older adults who died from cancer and individuals living in institutions received a greater number of medications than those suffering from another condition or living in the community. The number of drugs increased more slowly for those living in an institution than in the community, however.

Sean M. Jeffery, PharmD, BCGP, FASCP, AGSF, a geriatric specialist, who was not part of the study, said he was not surprised by the results, which are applicable to the United States. “[The results] are generally consistent with the trends we see in prescribing here: Community-dwelling elderly use fewer meds than institutionalized elderly,” said Dr. Jeffery, who is the director of clinical pharmacy services of Integrated Care Partners, Hartford Healthcare, in Wethersfield, Conn. “The general categories of medications used are also fairly consistent with what you would see in the United States.”

However, just because it is more medication doesn’t mean that it is inappropriate medication, he reminded. “People use more medications in the last year of life, as they may be experiencing significantly worsening of symptoms that leads them to seek relief,” said Dr. Jeffery, who is also a clinical professor at the University of Connecticut School of Pharmacy, in Storrs.

However, the frequent continuation of long-term, preventive treatments probably is not needed in many cases. For instance, the researchers found that during their last month of life, a large proportion of older adults used platelet antiaggregants (45%), beta blockers (41%), angiotensin-converting enzyme inhibitors (21%), vasodilators (17%), statins (16%), calcium channel blockers (15%) or potassium-sparing agents (12%). Those who died of cancer saw the greatest increase in the number of prescription drugs, even when analgesics were excluded from the total count.

Dr. Jeffery said the prescribing shows that many clinicians have a difficult time predicting death, and therefore, might be reluctant to discontinue maintenance medications. The study also couldn’t capture the influence of family members on decisions regarding whether to withdraw medications. He added that singling out patients who were in hospice or receiving palliative care would have been helpful to see whether the same trends occurred in that population.

This is a role made for pharmacists, who can help clinicians decide when to discontinue unnecessary medications, as well as adjust needed medications based on the pharmacokinetics of the patient, he noted. “There is a growing push for deprescribing whereby clinicians would start the process of removing medications that are unwarranted, no longer aligned with the patients goals of care or are potentially harmful,” Dr. Jeffery explained.

However, the researchers noted that “the process of de-prescribing requires timely dialogue between the patient, family, and physician, and close monitoring of symptoms. It is also essential that patients and their relatives receive clear information about their options in terms of palliative care in order to counter the feeling of abandonment that they may experience when treatments are withdrawn.”

The researchers said polypharmacy during end-of-life care raises ethical questions about the potential futility of treatments close to death, citing issues such as increased adverse events.

“By continuing active treatments when death is likely, it creates a disconnect between the likelihood of death and the patients and families awareness that death is near,” said Dr. Jeffery, which could result in patients receiving treatments “that have no way of extending life but do incur potential harm, may hasten death and are still costly.”

The researchers suggested that clinical guidelines be developed to support practitioners in their effort to reduce potentially futile drug treatments near the end of life.

Until then, Dr. Jeffery suggested that pharmacists:

  • empower patients to talk about their medication goals of care;
  • perform an annual assessment of medication appropriateness;
  • engage Part D patients in comprehensive medication reviews; and
  • develop motivational interviewing skills to help patients with deprescribing.

A weakness of the study was that it did not include OTC medications, he added. “Don’t forget the OTC medications,” he said. “The number of medications people use and cycle through may be greater than expected.”