Overtreatment of Older People Near End of Life: A Qualitative Scoping Review of Modalities, Drivers, and Solutions

Abstract

This study aimed to understand the drivers better to help minimise further risks of overtreatment for older people near the end of life (dysthanasia). A systematic scoping review of any publication types released in Medline, Embase, and Cochrane databases from January 2002 to January 2023 were used. Deductive thematic analysis was conducted independently and concurrently by paired reviewers. Risk of bias assessed for primary studies only using a modified version of the COREQ checklist. Twenty-one studies met the inclusion criteria. Determinants included healthcare system factors, patient-centered care, family and caregiver, and clinician perspectives. This review confirms that despite almost two decades of recognition of the potential harms of overtreatment near the end of life, society, patients, and health systems have a role to play in reducing and addressing the determinants. We offer a range of solutions for clinicians, health service managers, and members of the public to consider.