What is it?
A program that exists in many long-term care facilities to reduce drug use and drug side-effects in seniors, help evaluate the need for many drugs, decrease the risk of medication errors, and to allow nurses to spend more time with residents on other activities.
There are two types:
1. The “Every Sunday” program – all drugs except for those listed below are withheld every Sunday.
2. The “Specific Drug Withhold” program – a particular drug is stopped for a period of one to four weeks, depending on the problem being managed, to see if a resident still needs it, or to see if the resident improves off of it.
What are the benefits?
Many elders take too many drugs: medications which also have significant side-effects such as nausea, rashes, drowsiness, constipation, confusion. Older folks are more sensitive to all drugs: they metabolize them more slowly, don’t have the reserves to cope with side-effects and react more severely to side-effects when they do occur, and are more likely to develop “delirium” (acute confusion) from drugs. There is good research to show that elders feel better and enjoy life more when they take fewer drugs. (please see the handout “Polypharmacy”.) By reducing the number of pills, there is less risk of receiving the wrong medicine and of having an allergic or other type of reaction.
Most seniors, from our experience, do not enjoy taking a lot of pills and their families testify how much better they look and feel when on fewer drugs. Fewer drugs give a resident a greater sense of freedom from total dependence on medication. Many people have been told they must stay on a drug “for the rest of their lives”, but we now know that for good geriatric care, drugs once thought to be “essential” are no longer necessary to an individual’s quality of well-being.
Which Drugs should not be stopped?
• Antibiotics for short-term treatment of infections.
• Insulin for maintenance of normal blood sugars in diabetics who need insulin.
• Ointments and treatments for pressure sores.
• Anticonvulsants for seizures.
• Certain heart or blood pressure drugs.
• Long term steroids.
• Chronic pain control drugs.
• Symptomatic treatments for those at the very end-of-life.
• Some “nerve” pills which must maintain a certain level in the blood.
How to get on the “drug holiday”?
Ask the nurse or your doctor about it.
1. Steinberg SK. Considerations in the implementation of drug holiday programs in LTC facilities. Can Pharm J. 1984; 117:214-6.