As we discussed last month, polypharmacy has been repeatedly linked to a greater frequency of adverse drug events, drug-drug interactions and hospitalizations.
Many clinicians may be reluctant to initiate discussions with older people, believing that they value medications and would resist de-prescribing.
Experiencing adverse effects may increase openness to de-prescribing. As we age, medications do not react the same as they would in younger individuals. Older persons have less lean muscle and more fat deposits, less body water, and a slower metabolism of some medications. This is the perfect environment for drug interactions and adverse drug events, which are experienced by older adults more frequently. Also, the older adult’s perception of the importance of a medication may be exaggerated if they have been taking it for many years, or were told that they would “need it for the rest of their lives.”
However, studies have shown that most elderly would be open to the idea of taking less medication if it made them feel better or experience less side effects. If the clinician is able to present clear information to the older adult about decreasing or stopping their medication to reduce the incidence of adverse events, they are much more likely to agree. Good communication is the key to helping older adults understand the potential benefits and harms of different options when trying to deprescribe medications.
After identifying medications that can be potentially harmful, or ones causing serious side effects and adverse events such as impaired physical and cognitive function or increased risk of falls, the clinician should start with those classes of medications that potentially do the most harm when deprescribing. Tapering the dosages slowly, and monitoring very closely can increase the success of removing these harmful medications in our older population.
Guardian Pharmacy Atlanta embraces the care of our older adults. Although we are a long term care pharmacy that dispenses medications, our clinical pharmacists utilize standard geriatric guidelines and protocols when reviewing medications, and never hesitate to recommend de-prescibing to our physicians when it is best for our patients. If you are interested in learning more about our services, please call 770-635-3301.