Drug Use in Older Adults with Amyotrophic Lateral Sclerosis Near the End of Life

BACKGROUND: Amyotrophic lateral sclerosis (ALS), with its certain prognosis and swift progression, raises concerns regarding the adequacy of pharmacological treatment, including the risk–benefit profiles of prescribed drugs. OBJECTIVE: Our objective was to evaluate the use of prescription drugs over the course of the last year of life in older adults with ALS. METHODS: We conducted a nationwide retrospective cohort study of older adults who died with ALS in Sweden between 2007 and 2013. The primary outcome was the number of prescription drugs to which individuals were exposed during the last 12 months before death. RESULTS: The overall proportion of individuals receiving ten or more different prescription drugs increased from 19% at 12 months before death to 37% during the last month of life. Institutionalization was independently associated with polypharmacy near the end of life (odds ratio 1.84; 95% confidence interval 1.42–2.39). CONCLUSION: Future research is needed to assess the time to benefit of treatments and to develop guidelines for medication discontinuation in advanced ALS.