No this is not a joke. The room they enter happens to be the clinic space of a practitioner I mentor. The older women are friends, both originally from the UK and they sit in on one another’s consultations sharing many of the same experiences: grief over loved ones lost, memories, laughter and both describe waking in the morning with a sense of dread, because they’re tired, feel they’ve lost their oomph, their motivation, their chutzpah…that’s mostly why they’ve come today.
But know what else these two have in common?
Both women are taking between 6-7 prescription medications a day, which meets the definition of polypharmacy (5 or more medications/day).
Never one to be anti-medication without a good reason, my interest was in regard to how typical their medication list read for this age group – how almost ubiquitous the proton pump inhibitors and statins in particular are. The third one in this common trifecta are antidepressants, (with almost 1 in 4 women > 75yrs taking these) but only one of the ladies is on one. It raises the question simply of whether some of their presenting complaints could be medication related, especially given their long duration of use, the lack of demonstrable treatment efficacy/success for some, e.g. both women still suffer reflux with one taking additional Gaviscon daily(!) and the plausibility that such drugs could produce or worsen their fatigue and flat mood. Which prescribing physician has reviewed their cases for potential adverse effects or performed a risk benefit analysis for each medication?
“In Australia medications account for more than 14% of the annual $140.2 billion health care expenditure. Older people are the major recipients of medications with those older than 65 contributing to more than half of all Pharmaceutical Benefits Scheme expenditure.” Poudel et al 2016
I am excited by the growing area of research on ‘de-prescribing’ in this patient group and hope that ultimately it clarifies & helps us all to rethink best practice etc. Blanket de-prescribing is not the answer, however, and could do more harm than good. But encouraging patients to go back to their prescribing physicians and report the lack of resolution of symptoms in spite of being medicated. query the possible role any of the meds could play in their current symptom picture and discuss with them their willingness to try alternatives…would be a great start.
Oh and I know I have it in for PPIs this month, but in case you didn’t see it, Medscape has an article called Deprescribing PPIs:An Algorithim…just saying: 😉
“I think there is some misinterpretation that when we say ‘deprescribing,’ we mean ‘completely stop the medication,'” she suggests. “But deprescribing is a variety of options. It could mean reducing the dose, using the drug only when you need it, or switching to a safer alternative. It’s important to communicate that, because if people believe that PPI deprescribing means always stopping the drug, then we are going to see people having gastrointestinal bleeding because they should have been taking it,” she cautions. Nonetheless, she is optimistic about deprescribing interventions for PPIs. “This guideline has been very popular,” she notes.” see Medscape for Deprescribing PPIs: An Algorithm.