Geriatrics
Approaches for addressing polypharmacy in hospice and palliative care to prioritize comfort and quality of life.
In hospice and palliative care, reducing polypharmacy focuses on patient comfort, symptom relief, and meaningful quality of life by streamlining medicines, reassessing goals, and engaging families in thoughtful, ongoing decision making.
Published by
Daniel Cooper
July 30, 2025 - 3 min Read
In hospice and palliative care, polypharmacy often emerges as a complex challenge where the goal shifts from disease modification to symptom relief, comfort, and overall life quality. Clinicians routinely face requests to continue multiple medications that once served chronic illnesses, yet the patient’s current trajectory emphasizes comfort over longevity. A careful review begins with mapping each drug’s purpose, timing, and potential interactions, alongside patient values and stated goals. The process requires clear communication among the care team, patients, and families, ensuring decisions reflect what matters most in the remaining life phase. Regular medication reconciliation helps prevent duplications, adverse events, and burdens that can erode daily well-being.
A practical approach starts with prioritizing symptom targets and safety. Clinicians evaluate whether each medication contributes to relief or poses unnecessary risks, such as hypotension, delirium, or excessive sedation. Deprescribing is not abandonment of care but a deliberate redirection of therapeutic aims. Shared decision making becomes essential, inviting patients or their surrogates to articulate preferences about comfort versus functional activity, appetite, sleep, and cognitive clarity. Evidence-informed guidelines support the process, yet individualized judgments remain crucial. In many cases, simplifying regimens by stopping nonessential drugs reduces pill burden and lowers the chance of drug interactions, ultimately easing caregiving tasks and improving perceived quality of life.
Reduce burden by reviewing each drug’s necessity and impact.
Aligning therapeutic choices with patient-centered goals in hospice settings requires a framework that honors what matters most to each person. Clinicians begin by documenting prioritized outcomes—such as relief from dyspnea, reduced agitation, stable hydration, or maintained dignity—and ensuring these goals drive every medication decision. The team then conducts a granular review of each drug’s benefits, burdens, and alternatives. This transparent, goal-driven process helps families understand why certain medicines are discontinued and how such decisions may lessen side effects. It also fosters trust by demonstrating consistent attention to comfort, pain control, sleep quality, and emotional well-being as life draws to a close.
Ongoing conversation is central to sustaining appropriate polypharmacy practices. Regular multidisciplinary rounds provide space to reassess medications in light of evolving symptoms, new care preferences, or shifts in prognosis. Nuanced considerations include evaluating continuations of chronic disease therapies that may no longer influence comfort, as well as recognizing the impact of polypharmacy on cognitive clarity and risk of adverse events.Documentation should capture rationales for changes, ensuring that future caregivers understand the patient’s trajectory and the intended balance between symptom relief and potential long-term burdens. This iterative communication protects dignity and aligns care with patient wishes.
Center patient comfort, safety, and dignity in every decision.
A thorough medication review in hospice involves more than listing drugs; it requires clinical judgment about the real-world effects on daily living. Pharmacists and prescribers collaborate to identify medications with diminishing return at the end of life, such as those whose benefits accrue over years rather than weeks or days. By rebalancing therapies toward comfort-enhancing agents, clinicians can minimize adverse effects like dry mouth, constipation, or sedation that hinder participation in meaningful activities. Families gain confidence when they see a plan centered on relief from distressing symptoms rather than aggressive disease control. The process also supports safer administration, reducing the risk of errors amid caregiving routines and evolving care environments.
Deprescribing in this setting emphasizes patient autonomy and surrogate decision making. When patients cannot express preferences, clinicians rely on known values and previously stated wishes to guide reductions or eliminations. Safeguards include tapering schedules for medications where abrupt stopping could cause withdrawal or rebound symptoms, and ensuring alternative nonpharmacologic supports are available. Education for families about what to monitor after changes helps prevent misinterpretation or distress. The ultimate aim is to preserve dignity, minimize treatment burden, and maximize comfort, even as life circumstances shift and care goals evolve.
Build compassionate communication to support informed choices.
Safety considerations are paramount when adjusting medications in hospice. Clinicians assess drug interaction risks, renal and hepatic function changes, and the vulnerability of older adults to polypharmacy-related complications. Simplifying regimens can reduce the likelihood of dosing errors, and it often makes adherence more feasible for family caregivers. The strategy includes prioritizing non-drug approaches for symptom control when appropriate, such as positioning for breathing ease or environmental modifications to improve sleep. By focusing on nonpharmacologic comfort strategies alongside judicious drug use, care teams can sustain patient dignity and minimize distress.
Communication with patients and families is the cornerstone of successful polypharmacy management. Clear explanations about the rationale for stopping or altering therapies help prevent confusion and mistrust. Teams should provide written summaries of medication changes, expected symptom trajectories, and when to seek help for emergent issues. Shared decision making respects patient values, clarifies trade-offs, and strengthens relationships among the care team, patient, and loved ones. This open dialogue supports ongoing alignment between clinical actions and personal definitions of quality of life, particularly as expectations and capacities shift over time.
Maintain an adaptable, patient-centered medication plan.
Ethical considerations guide every deprescribing discussion in palliative care. Clinicians balance beneficence with autonomy, ensuring that the patient’s voice remains central, even when decisional capacity fluctuates. The emotional weight of stopping a long-standing medication can be heavy for families; empathetic framing helps reframe the change as a purposeful step toward comfort. Palliative teams routinely review whether continuing a medication aligns with comfort goals and overall prognosis, considering the patient’s prior experiences and cultural values. Ethical practice also involves documenting consent, preferences, and the intended course of action in a transparent, accessible manner.
Integrating a structured framework for evaluating medications supports consistency. Checklists that assess indication, effectiveness, safety, and patient priorities enable teams to document decisions systematically. Regularly revisiting the medication list during visits ensures that changes remain aligned with current symptoms and goals. Multidisciplinary input from physicians, nurses, pharmacists, and social workers enriches the appraisal by incorporating diverse perspectives on comfort, function, and caregiver burden. The outcome should be a streamlined regimen that minimizes risk while maximizing symptom relief and emotional peace for the patient and family.
Training and protocols help sustain best practices in polypharmacy management. Education for clinicians on deprescribing principles, end-of-life pharmacology, and communication skills equips teams to handle challenging conversations with sensitivity. Institutions may develop policies that encourage prompt medication reviews during transitions of care, such as between hospital, home, or hospice settings. Embedding decision aids, patient stories, and family scenarios into training fosters practical understanding of how choices affect daily life. When teams are prepared, the care environment becomes more consistent, and patients experience steadier symptom control and improved emotional well-being.
Finally, measuring outcomes thoughtfully supports ongoing improvement. Documentation of symptom relief, adverse effects, caregiver burden, and patient satisfaction helps determine whether current practices meet comfort goals. Quality metrics might include time to discontinuation of nonessential medications, incidence of delirium, and rates of hospital avoidance due to medication-related issues. Feedback loops from families and frontline staff inform refinements in deprescribing approaches, ensuring that hospice and palliative care continue to prioritize dignity, autonomy, and tranquil, meaningful moments.
