Some of you will shout “It’s about time that we address the subject of the many medications the elderly population takes.” This is primarily because you realize that the medications are not being monitored adequately and in the brief time your family member is seen, there has been no review of the regimen he/she is taking.
Increasingly, the number of elderly patients nationwide are on multiple medications to treat chronic conditions, thus raising their chances of dangerous drug interactions and serious side effects. Often different specialists who don’t even communicate with each other prescribe the drugs. If those patients are hospitalized, doctors making the rounds add more drug to the list — and some of the drugs they prescribe may be unnecessary or unsuitable.
University of Michigan researchers recently reported that the percentage of people older than 65 taking at least three psychiatric drugs more than doubled in the nine years beginning in 2004. Nearly half of those taking the potent medications, which include antipsychotic drugs used to treat schizophrenia, had no mental health diagnosis.
New Trend Regarding Prescribing
Medscape reported the findings of a Canadian Pharmacist, Barbara Farrell who co-founded the Canadian Deprescribing Network, a group seeking to drastically reduce inappropriate medication use among Canadian seniors by 2020. She has also helped write deprescribing guidelines used by doctors in the United States and other countries, to safely discontinue widely used drugs like proton pump inhibitors and sedatives. These guidelines enable the practitioners to weed out duplicative and potentially harmful drugs and reduce the doses of others.
A recent study by a team from the Boston VA Healthcare System found strong support among doctors for this concept. However, the team found was that not only are some doctors reluctant to discontinue medications, patients, too, can be wary. They may say, ‘I tried stopping my sleeping pill and I couldn’t sleep the next night, so I figured I needed it,’” Farrell said. ” Nobody explained to them that rebound insomnia, which can occur after stopping sleeping pills may last three to five days.”
The American Geriatrics Society (AGS) released its second updated and expanded Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, commonly called the guidelines for healthcare professionals to help improve the safety of prescribing medications for older adults. They emphasize deprescribing medications that are unnecessary, and ultimately reduce the risks associated with polypharmacy. Sample guidelines include:
1. Doctors should actively focus on “the big picture” and carefully weigh whether the benefits of a drug outweigh its risks.
2. Remember in geriatrics, “less is more.”
3. Begin every appointment with a review of medications; ask patients to bring with them.
4. Doctors are to record why a drug is being prescribed.
Controversy….Deprescribing Faces Formidable Obstacles
Although support is growing, deprescribing faces formidable obstacles. Among them, experts say, is a scarcity of research about how best to do it. Then there is the relentless advertising that encourages consumers to ask their doctors for new drugs. (Only allowable in the US and Australia.)
Next, there is a strong disinclination to countermand what another physician has ordered.
Also, performance measures are exacted as a mandate to prescribe drugs even when they make virtually no sense, such as giving statins to terminally ill patients. According to Mishori of Georgetown University, “It’s very typical to see a patient who has a few episodes of reflux and is then put on a (proton pump inhibitor, or PPI) and a few years later are still taking it.”
Many experts say the heartburn drugs are overprescribed, and studies have linked their long-term use to fractures, the risk of serious conditions such as Clostridium Difficile, commonly called “C-Dif”, infection, osteoporosis, pneumonia, dementia and premature death. Brownlee, the author of “Over treated: Why Too Much Medicine is Making Us Sicker and Poorer” points out that fragmentation of care is at the root of the over prescribing problem.
We’re On The Threshold Of Change
Many doctors who prescribe drugs in hospitals don’t consider how long those medications might be needed. There’s a tendency in medicine every time a medication is started there has been a tendency to never stop it. When doctors in the hospital change or add to the list of medications, patients often return home uncertain about what to take. If patients have dementia or are unclear about their medications, and they don’t have a family member or a caregiver to help, the consequences can be disastrous.
It Is Figuring Out What They Need Versus What They Can Survive Without
We can all be encouraged by the growing trend to deprescribe. We must be vigilant and do our part as well, ensuring the doctor is weighing the risks versus the benefits of medications for you or your elderly loved ones.
The physician’s chief role is to figure out what they need versus what they can survive without.