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GERICLINICS

Reference · End-of-life care

End-of-life care: the last weeks and days

Which medicines to continue, stop or start in the last months of life, and drug management of terminal delirium, breathlessness, nausea, bleeding, fever and palliative sedation in older people, summarised from a European end-of-life prescribing consensus and a 2026 GRADE-based geriatric palliative care guideline.

Source
European expert panel (Delphi consensus) (2018) — Morin L, Laroche ML, Vetrano DL, Fastbom J, Johnell K. Adequate, questionable, and inadequate drug prescribing for older adults at the end of life: a European expert consensus. Eur J Clin Pharmacol. 2018;74(10):1333–1342.
Last updated
21 October 2026
Checked against source
21 October 2026
Clinical review
Needs clinical reviewNot yet reviewed by a clinician. Check against the source before relying on it.

Grades are shown as the source states them. The 2026 guideline grades recommendations as strong (1) or weak (2) with evidence certainty from high (A) to very low (D). The European consensus rates drugs as often adequate, questionable or often inadequate for people aged 75 or over expected to live 3 months or less, with at least 75% expert agreement.

Key recommendations

  • In the last months of life, shift prescribing to comfort. Often adequate to continue: opioid and non-opioid analgesics, antiemetics, laxatives, systemic corticosteroids, butylscopolamine, benzodiazepines, antiepileptics, levodopa, thyroid hormone, and inhaled salbutamol, ipratropium or corticosteroids.

    Table 2 (continuation)European expert panel (Delphi consensus) 2018

  • Often inadequate to continue: lipid-lowering drugs, vitamin D and calcium, bisphosphonates and other osteoporosis drugs, antidementia drugs, peripheral vasodilators, immunostimulants, non-glycoside cardiac stimulants, and the antihypertensives in ATC group C02 (such as centrally acting drugs). ACE inhibitors, ARBs, calcium channel blockers, thiazide-type diuretics, anticoagulants, antiplatelets and sulfonylureas were rated questionable, to be decided case by case.

    Table 2 (continuation)European expert panel (Delphi consensus) 2018

  • For delirium, find and treat reversible causes (dehydration, infection, metabolic disturbance, drugs, pain) and use non-drug measures first: orientation, family presence, day–night routine, glasses and hearing aids, early mobilisation. Consider an antipsychotic (haloperidol, risperidone or olanzapine) only for marked distress or safety risk; benzodiazepines are not first line.

    Weak; low certainty (2C)Recommendations 51, 52 and 54National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University (guideline working group) 2026

  • For refractory breathlessness, once reversible causes have been addressed in line with goals of care, low-dose immediate-release oral morphine may be considered, with monitoring after starting and after each increase.

    Weak; low certainty (2C); monitoring Strong; moderate certainty (1B)Recommendations 10–11National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University (guideline working group) 2026

  • When symptoms are refractory and suffering intolerable, proportionate palliative sedation with midazolam may be considered after multidisciplinary discussion and informed consent; its aim is relief of suffering, not shortening life.

    Weak; moderate certainty (2B) for delirium; Strong; low certainty (1C) for breathlessnessRecommendations 14, 34 and 56National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University (guideline working group) 2026

Diagnosis

Investigations

Not covered in this summary — see the original guideline.

Treatment

Important geriatric considerations

Drug doses

When to refer

Red flags

Recent updates

References

Cited in this summary, followed by other guidelines on this topic.

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