VICTORIA, B.C.—Working aggressively to reduce their daily medication burden may be the single best thing we can do to improve the quality of life of our aging parents and grandparents.
The issue of too much medication in Canadian seniors is finally starting to be recognized as the serious problem it has become. Seniors are particularly vulnerable to the adverse effects of too many prescription drugs because aging affects their ability to process medications.
The statistics behind polypharmacy in the elderly—the term describes the simultaneous use of multiple medications—are surprising. In Canada, nearly 70 percent of all seniors take five or more drugs and almost 10 percent take 15 or more medications.
Many hospitalizations in the elderly are caused by adverse medication reactions, according to several recent studies. And one of the biggest health hazards for seniors is falling—often a result of multiple medications, which can cause cognitive difficulties and affect balance.
The good news is awareness of the scale of the problem is growing. More and more physicians are initiating “deprescribing” discussions with their older patients. “Deprescribing” is simply the deliberate and conscientious stopping or tapering 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. A recent massive Canadian Foundation for Healthcare Improvement 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. Canada’s new 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 have shown themselves to be nervous when initiating deprescribing activities, worried that they are reducing medications that specialists or other doctors have ordered. Publicly-funded medication reviews conducted by pharmacists can be flawed too, a CBC Marketplace investigation has found. Some reviews may be motivated by business reasons, 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.
