Polypharmacy and potentially inappropriate medications in patients requiring palliative care in hospitals and nursing homes: Evidence from a Ligurian point-prevalence multicenter study

OBJECTIVES AND BACKGROUND: Older adults with multimorbidity and frailty frequently require palliative care, yet prescribing practices often remain focused on primary or secondary disease prevention rather than symptom relief. Polypharmacy and potentially inappropriate medications (PIMs) may undermine quality of life and alter the benefit-to-harm ratio in this population. This study evaluated the prevalence of polypharmacy, pharmacological prescribing patterns and PIMs in hospitalized older adults requiring palliative care. STUDY DESIGN: This nested study of the Italian multicenter point-prevalence study (Palliative Care 2.0) included patients aged ≥65 years from three metropolitan hospitals and three nursing homes in Genoa, Liguria, Italy. Needs for palliative care were assessed using the NECPAL CCOMS-ICO© tool and those categorized as 'positive' were staged I-III. Polypharmacy (≥5 drugs) and five PIMs were evaluated according to STOPP-Frail criteria. Data were analyzed through appropriate hypothesis tests (Mann-Whitney, Anova, chi-squared) comparing NECPAL positive and negative participants, while associations with number of PIMs were explored through regression analysis. RESULTS: Of 558 patients initially screened, 294 were administered the NECPAL tool, of whom 254 (45.5% of the sample screened) had PC needs (mean age 85 ± 11 years; 61% female). Polypharmacy was reported in 93.9% (276/294), with a median of 9 drugs (IQR 5). PIMs were identified in 68.2% of patients and were strongly associated with polypharmacy (p < 0.001), but were less common in nursing home residents compared with hospital patients (p < 0.001). Drug burden and the prevalence of PIMs did not decline with advancing NECPAL stage, except for increased antidiabetic use in stage III. CONCLUSIONS: Polypharmacy and PIM use are highly prevalent in older adults who require palliative care, persisting even in advanced stages of illness. Current practice appears to fall short of both effective deprescribing and fully aligning pharmacological therapy with goals of care and overall quality of life. Systematic efforts to align pharmacotherapy with patients' care goals and clinical status are essential to minimize harm and promote quality of life in the final stages of life.

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Journal
Maturitas
Published
2026-03-31
DOI
https://doi.org/10.1016/j.maturitas.2026.108928
Primary Topic
Pharmaceutical Practices and Patient Outcomes
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article
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article

Polypharmacy and potentially inappropriate medications in patients requiring palliative care in hospitals and nursing homes: Evidence from a Ligurian point-prevalence multicenter study

Silvia Ottaviani, Domenico Cerminara, Stefania Peruzzo, Federico Gentilini et al.
Maturitas
Pharmaceutical Practices and Patient Outcomes
article

Polypharmacy and potentially inappropriate medications in patients requiring palliative care in hospitals and nursing homes: Evidence from a Ligurian point-prevalence multicenter study

Silvia Ottaviani, Domenico Cerminara, Stefania Peruzzo, Federico Gentilini, Alessio Nencioni, Erica Tavella, Paola R. Campodónico, Ekaterini Zigoura, Marina De Candia, Eleonora Arboscello, Maria Ghinatti, Claudia Bighin, Ilaria Indiano, Federica Boeri, Elisa Caratto, Lorenzo Stellino, M. Canepa, Fiammetta Monacelli, Federica Della Rovere, Lisa Cammalleri, Maria Concetta Scirocco, Fabio Ferrando, Barbara Senesi, Francesco Ottonello, Monica Pomata, Irene Giannubilo, Barbara Bonino, Luca Marri, Christian M. Lo Cascio, Andrea Guastalla, Francesca Dellacasa, Francesca Fezza, Clarissa Musacchio, Monica Pizzonia, Carlo Marani, Lucia Del Mastro, Margherita Milone, F E Tricerri, Marta Ponzano, Alberto Ballestrero, Giancarlo Antonucci, Federica Piccardo, Francesca Caserza, Luca Tagliafico, Camilla Prete, Francesca Gargiulo, Nicholas Bardi, Cinzia Bottaro, Federica Gandolfo, Laura De Mattei, Elena Bogliacino, Edoardo Giovanni Giannini, Fulvio Braido, Andrea Bellodi, Alessandro Ronda, Elena Page, Alì Jafal, Alberto Pilotto, Massimo Luzzani, Maria Chiara Stimolo, Paola Cianciosi, Emanuele Angelucci, Debora Tiso, Emanuela Barisione, Matteo Formica, Cristina Papandrea, Maria Corina Plaz Torres, Marta Ferrari, Francesca Specchia, Clarissa Ciaramidaro, Linda Kratochwilla, Lorenzo Ieni, Federico Molinelli, Lidia Piscina, Fabio Guolo, Anna Maria Gatti, Mariapaola Segalerba, Laura Camia, Alberto Sulli, Mona Mahmoud, Andrea Giusti, Federico Santolini, Francesca Dall'Acqua, Francesca Chiara Viazzi, Fabrizio Montecucco, Federico Carbone, Matteo Pardini, Francesco Torre, Guglielmo Bruzzone, Giulia Bozzo, Michela Mattioli, Angelo Schenone, Mimosa Lakrandi Sulthanagoda Manage, Federico Barà, Giulia Bartalucci, Carmen Pizzorni, Maria-Paola Fiamingo, Babette Dijk, Massimo Lemoli Roberto, Andrea Balestra
article en

Abstract

OBJECTIVES AND BACKGROUND: Older adults with multimorbidity and frailty frequently require palliative care, yet prescribing practices often remain focused on primary or secondary disease prevention rather than symptom relief. Polypharmacy and potentially inappropriate medications (PIMs) may undermine quality of life and alter the benefit-to-harm ratio in this population. This study evaluated the prevalence of polypharmacy, pharmacological prescribing patterns and PIMs in hospitalized older adults requiring palliative care. STUDY DESIGN: This nested study of the Italian multicenter point-prevalence study (Palliative Care 2.0) included patients aged ≥65 years from three metropolitan hospitals and three nursing homes in Genoa, Liguria, Italy. Needs for palliative care were assessed using the NECPAL CCOMS-ICO© tool and those categorized as 'positive' were staged I-III. Polypharmacy (≥5 drugs) and five PIMs were evaluated according to STOPP-Frail criteria. Data were analyzed through appropriate hypothesis tests (Mann-Whitney, Anova, chi-squared) comparing NECPAL positive and negative participants, while associations with number of PIMs were explored through regression analysis. RESULTS: Of 558 patients initially screened, 294 were administered the NECPAL tool, of whom 254 (45.5% of the sample screened) had PC needs (mean age 85 ± 11 years; 61% female). Polypharmacy was reported in 93.9% (276/294), with a median of 9 drugs (IQR 5). PIMs were identified in 68.2% of patients and were strongly associated with polypharmacy (p < 0.001), but were less common in nursing home residents compared with hospital patients (p < 0.001). Drug burden and the prevalence of PIMs did not decline with advancing NECPAL stage, except for increased antidiabetic use in stage III. CONCLUSIONS: Polypharmacy and PIM use are highly prevalent in older adults who require palliative care, persisting even in advanced stages of illness. Current practice appears to fall short of both effective deprescribing and fully aligning pharmacological therapy with goals of care and overall quality of life. Systematic efforts to align pharmacotherapy with patients' care goals and clinical status are essential to minimize harm and promote quality of life in the final stages of life.

MaturitasVol. 209
Pioneer (United States) (US), Association for Symbolic Logic (US), Ente Ospedaliero Ospedali Galliera (IT), Ospedale Policlinico San Martino (IT), Villa Torri Hospital (IT), University of Genoa (IT)
Ministero della Salute
Openalex Percentile: Top 36%
Pharmaceutical Practices and Patient Outcomes
DOIOpen Access PDFOpenAlex
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