Over four months ago, Elizabeth Carter and Leigh Purvis, researchers at AARP’s Pubic Policy Institute, released a study taking a look at the appropriate use and cost of the long-term prescribing dementia drugs. They concluded by urging health care providers to “regularly assess patients and their drug regimens to ensure these regimens remain appropriate reflecting the changing health status and needs of the patient.” The AARP researchers suggested more research can provide “up-to-date information on a drug’s effectiveness and side-effects that essentially can help increase the practice of de-prescribing medications that may no longer be of benefit, or even cause harm.”
This month, research presented in a new issue of the journal Public Policy & Aging Report from The Gerontological Society of America (GSA), makes a mirrored Carter and Purvis’s observations about the need to the de-prescribing of medications. The GSA study, “Comorbidity, Deprescribing, and the Healthcare of Older People,” notes that reducing the number of medications older adults use can have surprising benefits.
GSA Issue Takes a Look at Deprescribing Drugs
Titled “and supported by Age UK, ten articles in this issue explored the role of deprescribing — defined as the “the systematic process of identifying and discontinuing drugs in instances in which existing or potential harms outweigh existing or potential benefits within the context of an individual patient’s care goals, current level of functioning, life expectancy, values, and preferences — as a solution to polypharmacy”(the simultaneous use of multiple drugs to treat a single ailment or condition) in in older adults.)
James Goodwin, PhD, then the chief scientist at Age UK, served as guest editor. He joined with Public Policy & Aging Report Editor-in-Chief Brian Kaskie, PhD, of the University of Iowa to write an introduction for the issue’s ten articles.
They co-editors summarized the authors’ identification of factors that contribute to polypharmacy. They include the rise of co-morbidities and chronic long-term illnesses as the population ages. An increasing complexity in the delivery of health care, irrespective of the country, leading to problems of coordination between caregivers, physicians, and patients also is a contributing factor along with the huge numbers of prescription drugs available and their widespread use.
Other factors were also identified, including the creation of guidelines based on single diseases, randomized control trials of low external validity, and drugs untested in the older population, marginalization and disempowerment of older patients, with the absence of shared decision-making, and finally a culture in Western societies that is expectant of medical intervention at all levels.
Taking a Look at Ethical and Policy Issues Related to Deprescribing
The GSA articles in the new Public Policy & Aging Report collectively addresses both ethical and policy issues related to deprescribing of pharmaceutical drugs and explores the application of this approach in practice, including how to address obstacles to deprescribing.
“And as this edition shows, we know more than ever about the current state of polypharmacy, a modern epidemic which has the potential to blight the lives of millions of older people. Yet progress is slow,” say Goodwin and Kaskie. “Let us hope that by extending our understanding and the possibilities for improvement, we reduce the risks and increase the health and quality of life of our aging populations,” add the co-editors.