The overmedication of seniors is finally being recognized serious problem in Canada. Seniors are particularly vulnerable to the adverse effects of too many prescription drugs because aging affects their ability to process medications. Aggressively reducing their daily medication may be the best thing we can do to improve the quality of life of our aging parents and grandparents.
The statistics behind polypharmacy — the term that describes the simultaneous use of multiple medications — in the elderly are surprising. In Canada, nearly 70 percent of all seniors take five or more drugs, and almost 10 percent take 15 or more.
According to several recent studies, many hospitalizations of the elderly are caused by adverse reactions to medication. And one of the biggest health hazards for seniors is falling — often because of multiple medications, which can cause cognitive difficulties and affect balance.
The good news is there is now increased awareness of the scale of the problem. More and more physicians are initiating “deprescribing” discussions with their older patients. “Deprescribing” is exactly as it sounds — the deliberate and conscientious stopping or reducing of prescriptions to help improve health outcomes.
Some long-term care facilities are now required to do periodic medication reviews and weed out unnecessary, ineffective or hazardous pills. The recent massive Canadian Foundation for Healthcare Improvement demonstration project has shown how to reduce the inappropriate prescribing of antipsychotic medications to seniors with dementia.
Programs, research initiatives and physician-education activities on deprescribing are being carried out in most provinces. The Deprescribing Network is developing tools and information to help make deprescribing commonplace and part of the prescribing culture.
This is all a step in the right direction. Unfortunately, there’s still reluctance in some quarters to cut back on medications.
Some health-care providers become nervous when they initiate deprescribing activities, worried that they are reducing medications that specialists or other doctors have ordered. As well, publicly funded “medication reviews” that are conducted by pharmacists can be flawed, a CBC Marketplace investigation has found. Some reviews may be motivated by finance, resulting in more, not fewer pills for patients. The same report noted that even when done properly, medication reviews often miss the very patients who would benefit most from a review, such as the elderly or people on a high number of medications.
More than 90 percent of seniors say they want to reduce their medications, if a doctor suggests it. And who can blame them? No one wants to be on an expensive medication that has possible side effects and risks, if they don’t absolutely require the drug.
So what should be done?
Consumer-oriented literature on medicine tends to focus on “adherence” to and “compliance” with medications, and not on more appropriate drug treatment. And don’t forget that pharmaceutical manufacturers have a business incentive to increase volume, and they are not rewarded for appropriateness of prescribing.
Thankfully, the Canadian Deprescribing Network has identified a few areas in which the harm of drugs often exceeds the benefits. These include, but are not limited to, benzodiazepines and other sedative medication (commonly prescribed for sleeping), proton pump inhibitors (to treat ulcers and heartburn) and sulphonylureas (to treat type-II diabetes).
Drugs that can be problematic in combination with other medications include those that treat blood pressure and glucose. With these medications, high doses of multiple medications can lead to problems. They also flag the over-use of blood thinners, which require appropriate monitoring. According to the network, these are good places to start when you consult with your doctor.
If you do want to join the deprescribing revolution, don’t do it by yourself. Have a conversation with your doctor or pharmacist, who will be able to help you decide whether you are on the appropriate medications, which medications could be safely reduced or eliminated, and how to reduce or eliminate medications.
As people age they should be constantly asking whether a new medication is going to affect the things that are important to them: their mobility, cognitive abilities and ability to enjoy life.
Caregivers and, most importantly, seniors, have to be ready to assert their wishes when it comes to taking too many medications, and they should always be alert to the possibility that more medication might mean more problems.
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