‘Deprescribing’ in Seniors: Is Mom or Dad Taking Too Many Meds?
Posted: 10/9/2018 5:08 PM by
Contributed by Kathleen Doheny
An older adult’s list of prescribed medications can get surprisingly long. More than a third of people age 62 to 85 take five or more prescription medicines at the same time, according to a 2016 study.
If your loved one is taking meds that were prescribed a while ago, it’s time to check the list to see if he or she still needs all those pills, and whether the dosages of some could be safely decreased. The process of subtracting medications or lowering the dosage is called “deprescribing,” and it’s an important but often an overlooked part of senior healthcare.
"As people get older, their bodies process medication differently and the body responds to medications differently. Lower doses can reduce side effects but still achieve the same benefit,” says Barbara Farrell, PharmD, a clinical pharmacist at the Geriatric Day Hospital, Bruyere Continuing Care, Ottawa, Canada. She is also a scientist at the Bruyere Research Institute and co-founder of deprescribing.org.
A senior may be able to not only reduce dosages but stop taking certain meds that may no longer be needed. As the number of medications goes up, so do the chances of drug interactions and unwanted side effects. "The more medicines you are on, the more likely there will be a drug interaction," says Michael Koronkowski, PharmD, clinical assistant professor of pharmacy—geriatric medicine at the University of Illinois at Chicago. He adds, “If you are taking four medicines that can cause falls, the risk of falls is much higher."
Certain medications may do more harm than good in elderly patients, increasing the risk of confusion, irritability and falls, for example. See the Beers Criteria for a list of medications that may be inappropriate for seniors. If your loved is taking one of these, his or her doctor should take a good look at whether the benefits are still outweighing the risks.
Be aware, too, of ''prescribing cascade," advises Koronkowski. That's when a new medication is prescribed to treat a side effect of a medication already being taken. For example, diuretic or ''water pill" may cause frequent urination, and then another pill may be prescribed to address that issue.
How to start the process
"De-prescribing is a procedure of shared decision making with the patient or family caregiver and the provider," says Koronkowski. Start by talking to your loved one about it.
Some older adults may have been taking the same medications for so long they are reluctant to even talk about giving them up. Farrell and Koronkowski suggest broaching the subject gently while focusing on the aim — to keep them healthy and help them feel their best.
Ask your loved one to gather all the medications he or she takes. Look together at what they are for, and consider whether they are working and which provide the most benefit.
“When we begin the process of deprescribing, we need to figure out which medications are most important to the patient,” wrote Ranit Mishori, MD, professor of family medicine at the Georgetown University School of Medicine, in a recent article in Medscape aimed at physicians.
Also ask if they think any new symptoms, such as confusion or falls, might be linked to medicines they take.
The next step is for mom or dad to request a medication review at their next doctor’s visit. Doctors know these reviews are important, but office visits are short, and the task often falls off their to-do list. They may need prompting, especially when it comes to deprescribing, which can require careful thought and planning.
"You have a right to have your medications reviewed every time you go to the doctor and there is another medication decision made,'' Koronkowski says. He advises taking medicines, or a list of names and doses, to the doctor each visit. (Include over-the-counter medications and supplements.) It’s fine to ask directly whether any medications can safely be deprescribed.
Medication reviews are also a good idea when someone enters or leaves the hospital or moves into a care or retirement facility.
No one should stop any medication without talking to the doctor first — ideally the doctor who prescribed it. Some medications should be tapered, not stopped cold turkey. And of course, some shouldn’t be stopped at all.
Help is available, outside of the doctor’s office, for evaluating a person’s medication regimen. The pharmacist (whether mail order or local) can be a good source of information. Additionally, people on Medicare who have a Part D prescription plan or a Medicare Advantage plan may be eligible for a free program that can help them simplify their medication list. It's called the Medication Therapy Management Program. A pharmacist reviews each drug being taken, evaluates how well it works and any potential interactions and provides talking points to take to the doctor.
Medications are important when needed, but they can be overused, especially in older patients. When medication reviews become a regular part of health care, the result can be increased safety and, potentially, a higher quality of life.
Kathleen Doheny is a Los Angeles-based journalist specializing in health topics.