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Friday, December 9, 2016
over-medication of seniors
particularly vulnerable to the effects of too many prescriptions
Cassels Advisor EvidenceNetwork.ca
B.C. / Troy Media/ - 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.
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.
statistics behind polypharmacy in the elderly - the term describes the
simultaneous use of multiple medications - are surprising. In Canada, nearly 70
per cent of all seniors take five or more drugs and almost 10 per cent take 15
or more medications.
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.
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.
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.
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.
all a step in the right direction. Unfortunately, there's still reluctance in
some quarters to cut back on medications.
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
90 per cent 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 a potentially expensive medication
with possible side-effects and possible risks if they don't absolutely require
should be done?
Consumer-oriented literature on medicine tends to focus on adherence
and compliance to medications and not necessarily more appropriate drug
treatment. And we can't forget that pharmaceutical manufacturers have a business
incentive for volume and are not rewarded for appropriateness of
Thankfully, the folks from the Canadian Deprescribing Network have
identified a few areas where they see the harms of drugs often exceeding the
benefits. These include, but are not limited to, benzodiazepines and other
sedative medications (commonly prescribed for sleeping), proton pump inhibitors
(to treat ulcers and heartburn) and sulphonylureas (to treat type-II
can be problematic in combination with other medications include those that
treat blood pressure and glucose, where 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
a consultation with your doctor.
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 if you are on the appropriate medications, which medications could be
safely reduced or eliminated and how to do so.
get older, they should constantly ask if a new medication is going to affect the
things that are important to them: their mobility, cognitive abilities and
capacity to enjoy life.
and seniors, most importantly, have to be ready to assert their wishes when it
comes to taking too many medications and always be alert to the possibility that
more medication might mean more problems.