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Polypharmacy patterns in the last year of life in patients with dementia

Research output: Contribution to journalArticle

Original languageEnglish
Number of pages9
JournalEuropean Journal of Clinical Pharmacology
Early online date25 Jul 2019
DateAccepted/In press - 11 Jul 2019
DateE-pub ahead of print (current) - 25 Jul 2019


To describe prescribing of medicines in primary care in the last year of life in patients with dementia.
A retrospective cohort analysis in UK primary care using routinely collected data from the Clinical Practice Research Datalink. Number of medications and potentially inappropriate medication prescribed one-year prior to, and including death, was ascertained.
Dementia patients (n=6,923) aged 86.6±7.3 years (mean±SD), were prescribed 4.8±4.0 drugs one-year prior to death, increasing to 5.6±4.0 two-months prior, before falling to 4.9±4.1 at death. One-year prior to death, 50% of patients were prescribed a potentially inappropriate medication, falling to 41% at death. Cardiovascular medications were the most common, with decreases in drug count only occurring in the last month prior to death. Prescriptions for gastrointestinal and central nervous system medication increased throughout the year, particularly laxatives/analgesics, antidepressants, and hypnotic/antipsychotics. Women, (vs. men), and patients with Alzheimer’s (vs. vascular dementia), were prescribed 4.7% (95% CI 2.3%-7%) and 14.6% (11.7-17.3%) fewer medications, respectively. Prescribing decreased with age and increased with additional comorbidities.
Dementia patients are prescribed high-levels of medication, many potentially inappropriate, during their last year of life, with reductions occurring relatively late. Improvements to medication optimisation guidelines are needed to inform decision-making around deprescribing of long-term medications in patients with limited life-expectancy.

    Research areas

  • dementia, polypharmacy, inappropriate prescribing, end-of-life

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