We had an amazing Grand Rounds this morning with Dr Ariel Green, accomplished journalist and Geriatrician from John Hopkins Medical Center. Today she revealed the harmful effects of polypharmacy in the elderly and strategies to deprescribing.
Concerning Statistics for Older Adults: 36% of all adults take greater than 5 medications, with 17% of them taking over 10 medications! 20-30% of older adults are taking medications on lists of drugs to avoid, with 11% of ER visits are due to adverse drug events!
Medication Stewardship: A more thoughtful approach to prescribing includes prescribing based on best available benefit >> harm, goal aligned NOT guideline driven prescribing, using other therapies, ongoing monitoring and re-evaluation, and involve patient and caregivers in decisions.
What is Deprescribing: The structured and supervised process of withdrawal, dose reduction or substitution of an inappropriate medication with the goal of improving health outcomes and quality of life!
Deprescribing is Effective and Safe: A comprehensive meta-analysis has shown that deprescribing may reduce mortality and is safe! Deprescribing anti-hypertensives showed no increase in mortality, deprescribing psychotropics and benzo were associated with reduction in falls and improved cognition and daily function, and deprescribing statins with life limiting illness was safe and associated with better quality of life!
How to Deprescribe: This is a personalized approach that is specific to each patient. The overall approach however should incorporate the patient’s and caregiver’s goals. First identifying “what matters most” to the patient (ie what makes you happy, or what do you want to focus on?). Then find which medication to deprescribe addressing which medications have greatest harm to least benefit, are easiest to discontinue, and patient is most willing to discontinue. Deprescribing requires patient/caregiver buy in and should be framed in a positive light. It will need constant monitoring and communication.