Polypharmacy and Potentially Inappropriate Medications at the End of Life: Prevalence,Predictors,and Deprescribing Implications From a STOPPFrail Study

Abstract

Objectives

Polypharmacy and potentially inappropriate medications (PIMs) are common among end-of-life older adults and may cause harm while offering limited benefit. Evidence from Asia remains scarce. This study aimed to determine the prevalence of polypharmacy and PIMs, and to identify associated factors using the Screening Tool of Older Persons’ Prescriptions in Frail adults with limited life expectancy (STOPPFrail) version 2.

Methods

We conducted a retrospective cross-sectional chart review of patients aged ≥60 years referred to the Palliative Care Unit at Thammasat University Hospital, Thailand, between January and December 2021. Polypharmacy was defined as the concurrent use of ≥5 medications. PIMs were identified using STOPPFrail version 2. Logistic regression was applied to examine associations between demographic and clinical variables and polypharmacy or PIM use.

Results

Of 384 patients screened, 244 met inclusion criteria. The mean age was 75.7 years, and 51.2% were male. Polypharmacy was observed in 82.8%, while 93.7% received at least one PIM. Factors significantly associated with polypharmacy included hospital stay ≥11 days (OR 2.43, 95% CI 1.12-5.29, P = .025) and a higher number of symptoms (OR 1.61, 95% CI 1.00-2.58, P = .048). PIM use was associated with a Palliative Performance Scale of 30% (OR 6.23, 95% CI 1.13-34.47, P = .036) and polypharmacy (OR 17.95, 95% CI 4.42-72.99, P < .001).

Conclusions

Polypharmacy and PIMs are highly prevalent among end-of-life older adults in Thailand. These results highlight the need for systematic medication review and deprescribing strategies, supported by multidisciplinary teams, to reduce medication burden and improve patient-centered palliative care.