Deprescribing: A Pathway to Safer Aging
Dec 12, 2024
Consider talking to your healthcare provider about deprescribing. It could be the first step toward safer, more effective medication management and healthier aging.
As people age, managing our health often involves taking multiple medications to address chronic conditions. However, the risks of polypharmacy—the simultaneous use of multiple drugs—can sometimes outweigh the benefits, leading to adverse effects and reduced quality of life. Enter deprescribing: a systematic approach to reducing or stopping medications that may no longer be necessary or beneficial. Led by experts like Dr. Michael Steinman, this innovative practice is transforming elder care and empowering seniors to age more safely and comfortably.
What is Deprescribing?
Deprescribing is the process of carefully evaluating a patient’s medication regimen to identify and discontinue drugs that are no longer needed, potentially harmful, or misaligned with the patient’s health goals. Far from simply stopping medications, deprescribing involves collaboration between healthcare providers, patients, and caregivers to ensure that medication changes are made safely and thoughtfully.
Dr. Michael Steinman, a leading voice in geriatric medicine and a professor at the University of California, San Francisco, has been at the forefront of deprescribing research. His work emphasizes the importance of individualizing care, recognizing that what works for one patient may not be appropriate for another. You can listen to our podcast episode with him here: Dr Steinman Episode.
The Risks of Polypharmacy
Polypharmacy, defined as the use of five or more medications simultaneously, is a growing concern among older adults. It often arises when patients are treated for multiple chronic conditions, requiring various medications. While these drugs may each have a valid purpose, their combined effects can be problematic, leading to unintended consequences.
According to a study published in JAMA Internal Medicine (Maher et al., 2014), nearly 40% of older adults take five or more medications. This practice increases the likelihood of:
Adverse Drug Events (ADEs): Side effects, drug interactions, and toxicity.
Cognitive Impairment: Some medications can contribute to confusion, memory issues, or delirium.
Falls and Frailty: Sedatives or blood pressure medications may increase the risk of falls. Nausea or drowsiness can be issues of interactions or side effects of one drug.
Diminished Quality of Life: Managing a complex regimen can be overwhelming, and the side effects may outweigh the benefits.
As Dr. Steinman’s writes at the beginning of his paper "Overcoming Inertia to Improve Medication Use and Deprescribing: Patients, Pharmacists, and Physicians"
Inertia is a powerful force. Stopping or starting is difficult, in health care as well as in other sciences. Ineffective or potentially harmful treatments are often not stopped, even years after they have been started, and effective treatments are too often not started at all.
Once started, medications can be difficult to stop. It takes time for office-based clinicians to reassess use of medications prescribed for chronic diseases, particularly therapies that are not clearly related to the complaints or conditions that are the focus of a given patient encounter. Even if a clinician recognizes a medication as potentially inappropriate and a candidate for discontinuation, both clinicians and patients may be concerned that “the devil they know is worse than the devil they don’t know” and that symptoms or biomarkers may worsen if the drug is stopped, or that stopping a drug may be perceived as “giving up.” Clinicians also may be unsure about how best to taper different medications, or how to recognize and manage adverse drug withdrawal events. Thus, use of unnecessary and potentially harmful medications is common among older adults.
If new medications are prescribed to treat the side effects of others, we can create a cycle of overmedication.
The Process of Deprescribing
Effective deprescribing requires a structured approach. Here are the key steps:
Comprehensive Medication Review: A healthcare provider reviews all medications, including prescriptions, over-the-counter drugs, and supplements. If you don't disclose supplements, then interactions might not be known. Diet as well - it's well known that grapefruit interacts negatively with statins (cholesterol medications).
Assessing Necessity and Risks: Each medication is evaluated for its current relevance, potential side effects, and risks versus benefits.
Patient-Centered Decision Making: The provider discusses potential changes with the patient, considering their preferences, goals, and overall health.
Gradual Reduction: Medications may be removed gradually, if necessary, to avoid withdrawal symptoms or rebound effects.
Ongoing Monitoring: The patient’s response to medication changes is closely monitored, with adjustments made as needed.
Success Stories: Deprescribing in Action
Deprescribing has led to remarkable improvements in patient outcomes. For example, a case study in The BMJ (Scott et al., 2015) highlighted an older adult whose quality of life significantly improved after reducing her medication burden. She experienced fewer side effects, increased energy, and better cognitive function.
A Call to Action
Deprescribing is not about eliminating medications but ensuring that each one serves a clear, beneficial purpose. For seniors, caregivers, and healthcare providers, it offers a proactive way to enhance safety and well-being.
If you or a loved one are managing multiple medications, consider talking to your healthcare provider about deprescribing. It could be the first step toward a healthier, more comfortable aging journey.
It makes me think of subscription payments. We pay for so many subscriptions. When do we get advice on which ones we still need? Do we remember why we have them in the first place?
Get informed, read more at https://deprescribing.org
References:
Maher, R. L., Hanlon, J. T., & Hajjar, E. R. (2014). Clinical consequences of polypharmacy in elderly. JAMA Internal Medicine, 174(5), 845–850.
Scott, I. A., Hilmer, S. N., Reeve, E., et al. (2015). Reducing inappropriate polypharmacy: The process of deprescribing. BMJ, 349, g7013.