Our needs change as we age and prescription drugs appropriate for 40-year-olds may be unnecessary or even dangerous when we get to 80.
Medicines play an important role in helping people stay well, especially older people, many of whom live with several chronic illnesses.
“The more medicines you take, the higher the risk of medicine-related harm”Michelle Liacos
But it’s important to have those medicines reviewed by a health professional from time to time to check they’re still working for you, says pharmacist Michelle Liacos from Alfred Health in Melbourne, and her co-authors in an article published in Australian Prescriber, last month.
Each patient, together with their doctor, should look at stopping medicines when they are no longer needed to reduce the risk of medicine-related harm. This is known as deprescribing.
In the last 15 years the number of older Australians taking more than five different medicines has increased to nearly one million.
The more medicines taken the greater the risk of unwanted side effects.
It is also expensive for patients and the health system.
“The more medicines you take, the higher the risk of medicine-related harm, such as hospital admissions and falls,” says Ms Liacos.
“Studies have shown that, in some cases, reducing or stopping certain medicines may not worsen the disease they are treating, and may even reduce the risk of medicine-related harm.
“Every medicine can have unwanted side effects and it is not uncommon for these to be misinterpreted as a new disease. An example might be when someone is prescribed a particular medicine for Alzheimer’s disease then experiences bed-wetting as a side effect. The person may then be prescribed another medicine to manage the incontinence. But that medicine might also have side effects. This is called a prescribing cascade,” she said.
A significant event, like a fall should trigger a review. In a New Zealand study deprescribing sedatives and anticholinergic drugs (used to treat incontinence) reduced the number and severity of subsequent falls.
Many drugs are prescribed to prolong life, but randomised trials of deprescribing found no change in overall mortality.
Moreover, there is no point in prescribing long term preventive medicines, such as statins, to people with a short life expectancy.
Many older people are prescribed antihypertensives to reduce their risk of cardiovascular events. This needs to be carefully balanced with the potential for harms including falls and dizziness.
A study of frail older people found that deprescribing antihypertensives resulted in an immediate increase in blood pressure, although this reverted to baseline within nine months.
Blood pressure should be routinely monitored during the first year after deprescribing to identify increases that may occur.
There is recent evidence that the optimum blood pressure in frail older people is higher than in healthy younger people.
“These are all reasons why it is important to regularly check in with your health professional about whether you still need all the medicines you are currently taking,” Ms Liacos said.
A home medicines review carried out by a pharmacist can identify targets for deprescribing for discussion with your doctor.
“Reducing medicines should always be a joint decision between you and your doctor and done in a slow and careful way by careful monitoring and tapering the dose.
“If you have problems after you reduce or stop your medicine, the medicine can always be restarted if needed.
“Importantly, never stop taking a medicine without talking to your doctor or pharmacist, as stopping a medicine suddenly can be dangerous,” she says.
Choosing Wisely Australia is part of a global campaign to improve the quality of health care by encouraging clinicians, consumers and other stakeholders to have conversations about tests, treatments and procedures where evidence shows they provide no benefit or in some cases cause harm.