Seminar PH2: The elderly at risk: reducing medications safely to meet life’s changes

Linked to EAHP Statements

Section 4: Clinical Pharmacy Services
Section 5: Patient Safety

ACPE UAN: 0475-0000-17-015-L04-P. A knowledge based activity.

Abstract

Polypharmacy is common among older patients and often comes with an increased risk for negative health outcomes such as adverse drug reactions, drug-interactions, nonadherence, functional and cognitive decline, falls and higher healthcare cost. In responding to polypharmacy – related harm, a new term has entered the medical lexicon: deprescribing. The term deprescribing is used to describe the comprehensive process of tapering, stopping, discontinuing or withdrawing drugs, with the goal of managing polypharmacy and improving outcomes.

A systematic and patient-centred deprescribing process comprises several steps: compile comprehensive medication history; identify potentially inappropriate medications; assess each medication for eligibility to be discontinued; prioritise medications for discontinuation; monitor, support and document. Deprescribing is not free from harm, and potential adverse consequences of medication withdrawal (return of a medical condition, or other adverse drug withdrawal reaction) should be considered. Most of the harms of deprescribing can be minimised with proper planning, monitoring and with reinitiation of the medication if the patient’s condition returns. Barriers to deprescribing include fragmented care among multiple prescribers, ambiguous or changing care goals, uncertainty about the benefits, harms of continuing and discontinuing specific medications, fear of adverse effects, community and professional attitudes toward more rather than less use of medications, and limited consultation time.

Deprescribing requires coordination of health care providers and pharmacists can contribute to all steps of systematic deprescribing process. Different levels of pharmacist’s involvement are present in different countries. As such, we need to plan organisational models where the contribution of the pharmacist can have the maximum impact.

Learning Objectives

After the seminar, the participant should be able to:
• explain systematic and patient-centred deprescribing processes;
• describe the steps involved in deprescribing;
• demonstrate different models of pharmacist’s involvement. 

Keywords: deprescription, substitution, geriatrics, lag time to benefit, phenotypes

* No conflict of interest has been declared.