Polypharmacy and Deprescribing

deprescribing medications

The term “deprescribing” first appeared in medical literature in 2003. It describes the practice of backing off a prescribed medication when doses are too high, or stopping medications that are no longer needed. Deprescribing is a strategy to deal with polypharmacy, which is taking five or more medications daily.

Polypharmacy is harmful because in older patients, it imposes a significant burden of decreased physical functioning. Adverse drug events (ADEs) lead to an increased risk of falls, increased delirium, more hospital admissions, and in the most serious ADEs, death.

The Pros of Deprescribing

  • One in five prescriptions is potentially inappropriate in the elderly. For example, some types of diabetes medications (i.e. Actos), benzodiazepines over a long period of time, and anticholinergic medications.
  • Up to 10 percent of hospital admissions result from drug-related problems.
  • Appropriate prescribing consists of:
    • Regular review of indicated medications
    • Tapering then withdrawing the medications when the potential harm outweighs the benefits

The Cons of Deprescribing

  • Physicians have concerns about possible medical harm through withdrawing medications.
  • Potential harm to relationship with patients and families if medication is discontinued. Patients and families may think caregivers are giving up on the patient or trying to cut costs instead of trying for a good outcome.
  • Changing and reducing medications can create uncertainty about which medications patients were getting from different providers.
  • Deprescribing can have adverse events similar to polypharmacy: reduced quality of life, adverse drug reactions, addiction, falls, non-adherence, and hospitalizations.

How to Deprescibe

Deprescibing should be done under the supervision of healthcare professionals, including physicians, nurses, and pharmacists. The first step is to collect a comprehensive medication history. It should include supplements and vitamins as well as prescription medications.

Then, the patient’s adherence to medication taking needs to be assessed. The overall risks and benefits of deprescribing need to be assessed.

Healthcare givers should discuss the values and preferences of the patients, their families, and the caregivers. What are the goals of care surrounding the medications and their continuation? Once these are determined, providers can make a plan about dose reduction, switching to other medications where appropriate, or stopping the medication altogether.

For more information about polypharmacy, you can see our article here. For more information about deprescribing, see deprescribing.org. Teaching students of pharmacy and nursing about polypharmacy, proper medication prescribing and administration, the risks of ADEs, and how to advocate for their patients will go a long way to better patient outcomes, especially in older patients in long-term care homes.

As always, to teach medication administration, and educate about how medication looks and proper dosing, see the Demo Dose® family of simulated medications at Pocket Nurse.

Information for this post came from a presentation by Denise Kreckel, R.Ph., “Polypharmacy: Poly-drug, Poly-Problems,” which was presented at Strategies: Educational Excellence for Healthcare Providers and Educators 27th Annual Conference at Penn State University. This is part two of a series of posts based on her presentation. Kreckel is from the Centre Volunteers in Medicine in State College, PA.

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