Deprescribing Strategies in Long-Term Care
Inappropriate polypharmacy in older patients imposes a significant burden of decreased physical functioning and increased risk of falls, delirium and other geriatric syndromes, hospital admissions, and death. Deliberate yet judicious deprescribing has considerable potential to relieve unnecessary medication-related suffering and disability in vulnerable older populations.
In a Saturday AMDA session titled “Rational Deprescribing,” presenters discussed how to identify polypharmacy, alternatives to pharmacologic options, and medication interactions. The presentations centered around educating practitioners to recognize potential inappropriate medications based on the Beers and STOPP (Screening Tool of Older Persons' potentially inappropriate Prescriptions) criteria, to consider patient prognosis when prescribing or deprescribing, and to implement a systematic plan to review medication lists and deprescribe as necessary.
Presenter Ariel Cole, MD, FAAFP, CMD, Centre for Aging and Wellness, Florida Hospital, began the discussion by providing an overview of adverse drug reactions, which are the fourth leading cause of death in the United States, and of the barriers that typically hold physicians back from deprescribing, such as not being the primary care physician, family pressure, and the physician’s relationships with the patient.
The next presenters, John Fleming, MD, CMD, Indianapolis, IN; Wendy Ethridge, PharmD, CPh, Senior Care Pharmacy, Lakeland, FL; and Alan Obringer, RPh, CPh, also of Senior Care Pharmacy, then covered the top drugs that cause adverse reactions, reviewed the role of antibiotic stewardship in reducing the prescribing of antibiotics, discussed how and when to use sedatives and antipsychotics, and cautioned about the long-term risks of medications. Repeated themes in the presentations were finding non-pharmacological alternatives, paying special attention to individual patients’ cases and history, and using strategies for weaning medications.
- See more at: https://www.annalsoflongtermcare.com/article/2016-amda-annual-meeting#sthash.NreJBQNs.dpuf
