De-prescribing
What is de-prescribing?
Deprescribing is defined as “the process of systematically withdrawing inappropriate medication, in partnership with your doctor”. Deprescribing recognises that as people get older, that life goals change and therefore health prioritises change too. The medications that people take should reflect that. De-prescribing lets older people take only the medication that they really need.
Why is this important?
The potential benefits:
Simplification – fewer drugs to take are easier to remember
Reduced costs
Reduced chance of drug-drug interactions
Improve quality of life (e.g. can decrease risk of falls, cognitive decline)
Reduced administration errors
Can de-prescribing be harmful?
Lots of studies have shown that deprescribing is safe and well tolerated. The potential risks of stopping regular medications are to be discussed before beginning the process. De-prescribing should be done slowly and thoughtfully to minimise the risks of something bad happening.
When should we think about deprescribing?
There is never a wrong time to discuss deprescribing. Triggering events should prompt a review or medications. These include:
Being on a lot of medications (more than 5 drug types is called “poly-pharmacy”)
Experiencing side effects or drug-drug interactions
A change in health circumstances
Geriatricians’ recognise that as people’s health changes so should their medications. For instance, is it important for an 85 year old to use a cholesterol drug if the benefit can be only measured over many years. Also, certain drugs that affect the brain such as Valium, antidepressants and some strong-pain relief medications can increase falls.
What’s involved?
Deprescribing starts with an openness to review medications on the part of yourself and your GP. To assist with de-prescribing pharmacist can do a medicines reconciliation to identify potential side effects and drug interactions.
Geriatrician’s often drive de-prescribing conversations with people since they are familiar with problems associated with aging and how medications can be helpful, unhelpful or potentially harmful. Balancing the risk’s and benefits is important when prescribing or deprescribing. These are conversations that geriatricians are skilled in having. When done slowly and thoughtfully people report benefit including greater well-being and less bill-burden.
