Polypharmacy and potentially inappropriate medications in patients requiring palliative care in hospitals and nursing homes: Evidence from a Ligurian point-prevalence multicenter study

Objectives and background Older adults with multimorbidity and frailty frequently require palliative care, yet prescribing practices often remain focused on primary or secondary disease prevention rather than symptom relief. Polypharmacy and potentially inappropriate medications (PIMs) may undermine quality of life and alter the benefit-to-harm ratio in this population. This study evaluated the prevalence of polypharmacy, pharmacological prescribing patterns and PIMs in hospitalized older adults requiring palliative care. Study design This nested study of the Italian multicenter point-prevalence study (Palliative Care 2.0) included patients aged ≥65 years from three metropolitan hospitals and three nursing homes in Genoa, Liguria, Italy. Needs for palliative care were assessed using the NECPAL CCOMS-ICO© tool and those categorized as ‘positive’ were staged I–III. Polypharmacy (≥5 drugs) and five PIMs were evaluated according to STOPP-Frail criteria. Data were analyzed through appropriate hypothesis tests (Mann-Whitney, Anova, chi-squared) comparing NECPAL positive and negative participants, while associations with number of PIMs were explored through regression analysis. Results Of 558 patients initially screened, 294 were administered the NECPAL tool, of whom 254 (45.5% of the sample screened) had PC needs (mean age 85 ± 11 years; 61% female). Polypharmacy was reported in 93.9% (276/294), with a median of 9 drugs (IQR 5). PIMs were identified in 68.2% of patients and were strongly associated with polypharmacy (p < 0.001), but were less common in nursing home residents compared with hospital patients (p < 0.001). Drug burden and the prevalence of PIMs did not decline with advancing NECPAL stage, except for increased antidiabetic use in stage III. Conclusions Polypharmacy and PIM use are highly prevalent in older adults who require palliative care, persisting even in advanced stages of illness. Current practice appears to fall short of both effective deprescribing and fully aligning pharmacological therapy with goals of care and overall quality of life. Systematic efforts to align pharmacotherapy with patients' care goals and clinical status are essential to minimize harm and promote quality of life in the final stages of life.