Ethical and practical dimensions of prescribing for older people as quality of life decreases

Prescribing medicines for older people always presents difficulties, never more so than when quality of life decreases or the process of dying begins. The problem confronting doctors, and others caring for older patients, is the option of intervening or not intervening. The principles of bioethics can be used to assist those making decisions regarding the medical management of older people. Decisions that are made must consider the likely benefit and associated harms that may accrue from continuing or commencing treatment. Respect for individuals and their wishes must be maintained even when the patient's decision-making capacity is impaired and others need to make decisions for them. Management dilemmas include when to stop or reduce prescribing as the end-of-life approaches, the use of medication to manage behavioural disturbance, multiple medication use increasing the risk for harm and the use of drugs for which the evidence of benefit is not available for older patients or for which there is evidence of increased adverse effects that may impair quality of life. Those caring for older people must consider a wide range of options and can be assisted by asking key questions to help guide appropriate decision making.