Why Deprescribing for Seniors is Gaining Medical Steam

It isn’t in the dictionary. If you type it in an email, you’ll get that squiggly line underneath. Yet deprescribing is a word that’s getting a lot of attention in the medical world – particularly deprescribing for seniors.

Take 27 Pills and Call Me In the Morning

Yes, you read that right.

Studies show that 25% of 65-69 year old American seniors take 5 or more prescription medications on a regular basis, every single day. So do almost 50% of those between the ages of 70-79. But when hospitalizations occur, and seniors are seeing multiple doctors, the chances that they’re taking way more than 5 prescription meds a day go way up. Like the Canadian woman who ended up taking 27 pills, four times a day.

Admittedly, 27 pills is very unusual – and extreme. But her story highlights how easy it is to be taking way, way too much medication.

Enter deprescribing for seniors.

According to the Canadian Deprescribing Network:

Deprescribing means reducing or stopping medications that may not be beneficial or may be causing harm. The goal of deprescribing is to maintain or improve quality of life.

In other words, deprescribing means gathering together all the medications the patient is currently taking and checking why they’re taking each one – and if there are any that are a bad mix or that might be entirely unnecessary.

Of course, that’s much easier said than done. That’s because deprescribing requires a mindset shift not only for the patient but for the doctor as well. Whether due to lack of communication between multiple healthcare providers, lack of interest or lack of time (or all three), constant reevaluation of meds is not (yet) an intrinsic element of healthcare. Many patients feel it’s easier to take a pill than to begin the arduous, sometimes tedious process of lifestyle changes. Many doctors are rushed.

That’s not to say that more and more doctors aren’t getting behind deprescribing. Especially in the medical community of geriatrics, doctors are seeing patients take a lot more medications – and with higher rates of over-medication – compared to 20 years ago. These doctors will routinely ask patients questions like:

• Why was this medication started?
• Why is it needed now?
• What is the plan for monitoring/dealing with side effects?
• Is there a lifestyle substitute for this medication?
• Might a lower dose/frequency do the job?

Don’t try deprescribing at home.

A note of caution before we go on: Please do not, under any circumstances, try deprescribing for your loved one on your own – whether they live at home or if they’re in an assisted living or skilled nursing facility with round-the-clock doctors on site. Even if you’re sure that a certain medication is causing problems, take it up with their primary physician. Don’t make these kinds of decisions on your own, ever.

Why is deprescribing for seniors so important?

Well, first of all because as we said above, older adults are far more likely to be taking multiple medications. So deprescribing is for seniors somewhat by definition.

Beyond that:

• The Beers List. The American Geriatrics Society’s (AGS)  Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults, otherwise known as The Beers List, is a “compendium of medications potentially to avoid or consider with caution because they often present an unfavorable balance of benefits and harms for older people.” Even so, many seniors are still prescribed medications on that list. Deprescribing allows for screening to weed out these potentially problematic meds.
• Risk of falling and cognitive decline. There’s a not-insignificant number of commonly prescribed medications that can cause balance and gait issues, as well as increase the risk of mental decline. But your loved one might not know that. Deprescribing will clue them in.
•  Medical emergencies. According to the CDC, seniors are seven times as likely to be hospitalized after an emergency room visit than younger people are. But here’s the thing: Over half of those hospitalizations are due to an adverse drug event (ADE). The less medication your loved one needs to take, the less the chances of an ADE.

All of this might sound overwhelming. But for all the reasons listed here (and more), deprescribing for seniors is gaining a lot of steam – which makes it easier to broach the process with your loved one’s healthcare team.