1. Introduction
end-stage organ failure, cognitive, nutritional, geriatric syndromes, organ failure, dementia-like, Frail
DISEASE, CHRONIC DISEASES, PCP
This study aimed to comparatively analyze the effect of the person-centered prescription (PCP) model on pharmacotherapeutic indicators and the costs of pharmacological treatment between a dementia-like trajectory and an end-stage organ failure trajectory, and two states of frailty (cut-off point 0.5). A randomized controlled trial was conducted with patients aged ≥65 years admitted to a subacute hospital and identified by the Necessity of Palliative Care test to require palliative care. Data were collected from February 2018 to February 2020. Variables assessed included sociodemographic, clinical, degree-of-frailty, and several pharmacotherapeutic indicators and the 28-day medication cost. Fifty-five patients with dementia-like trajectory and 26 with organ failure trajectory were recruited observing significant differences at hospital admission in the mean number of medications (7.6 vs. 9.7; The prevalence of advanced chronic diseases and the mortality of patients with a limited life expectancy are notably increasing. These are linked to dependency, frailty, and multimorbidity with different degrees of complexity, need, and demand [The quantification of a frailty index based on the model proposed by Rockwood et al. [However, in practice, the use of medications increases because these patients accumulate more deficits, leading to a higher degree of frailty and increasing the likelihood of a fatal outcome. This is due not only to the use of medications to alleviate the symptoms associated with the disease, but also to long-term preventive treatments of questionable clinical benefit [Polypharmacy and potentially inappropriate prescriptions increase healthcare spending, which affects both the patient and the health system, in addition to causing adverse health outcomes. A study on the frequency and cost of potentially inappropriate prescriptions for older people in Canada estimated that $75 per patient and annum was spent on potentially inappropriate medications outside of hospital settings [The adequacy of pharmacotherapy is especially important in frail older people with limited life expectancy. This is often linked to the use of deprescription strategies in these patients [The person-centered prescription (PCP) model has been recently reported to reduce polypharmacy, potentially inappropriate prescriptions at EOL according to the Screening Tool of Older Persons’ Prescriptions in Frail adults with limited life expectancy (STOPPFrail) criteria [These two trajectories have been shown to be different in terms of many of the dimensions studied, such as functional, cognitive, nutritional, geriatric syndromes, and use of health resources; therefore, changes in the impact of the PCP model were expected.