Deprescribing! Get into it.

By Associate Editor, Roberta Heale, @robertaheale @EBNursingBMJ

By the time they become geriatric, people in North America are often prescribed multiple medications per day. In Canada 2/3 of people over the age of 65 take at least 5 prescription medications per day and ¼ take at least 10 prescription medications per day. https://bit.ly/2sgpiOx

There are medications meant to control cholesterol, hypertension, diabetes, osteoarthritis, etc.  Then there are the medications to counteract the side effects of the ones that are prescribed for medical conditions such as constipation, gastric reflux and more. Then there are prescriptions that do more harm than good leading to dependence and addiction. The trend of polypharmacy is being seen across the globe in developed countries.

There are many potential problems with polypharmacy including drug interactions, falls and fractures, memory problems, hospitalizations and higher risk of death. Those who are most vulnerable to the effects of polypharmacy are people with multiple chronic conditions, women and people over the age of 65 https://bit.ly/2sgpiOx

A commentary published in EBN’s recent edition titled Deprescribing in nursing homes is safe and should be pursued http://ebn.bmj.com/content/21/2/53 a is based on research which demonstrated that discontinuing inappropriate medication in nursing home residents is safe and feasible (Wouters, et al., 2017).

Nurses play a key role in identifying and addressing polypharmacy.  Appropriate assessments and ensuring policies in organizations for prescription reviews are a few important steps.  There are many resources to help.  Check out the links to NICE guidelines and the Canadian Deprescribing Network, as a few examples.  Putting deprescribing as a priority is a good first step.

Canadian Deprescribing Network. (2018). https://bit.ly/2sgpiOx

NICE. (2018). Multimorbidity and Polypharmacy.  https://www.nice.org.uk/advice/ktt18/chapter/evidence-context 

Wouters H, Scheper J, Koning H, et al. Discontinuing Inappropriate Medication Use in Nursing Home Residents: A Cluster Randomized Controlled Trial. Ann Intern Med. 2017 Nov 7;167(9):609-617

 

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