Polypharmacy Factors Pt 7

This is #7—and the final one—in the series about why we should be concerned with seniors taking so many pills:   Tips to reduce Polypharmacy.

 

A study published in 2010 in the Archives of Internal Medicine showed that it is possible to reduce a lot of the drugs seniors take and help them feel better, without causing any major problems.

The researchers asked several questions about each medication being taken, beginning with, “Is there good evidence to support using each drug for the indication given at its current dose and do the benefits outweigh all possible known side-effects?”  If the response was “yes”, then the drug was continued.  But, if the answer was “no or not sure”, they asked five more questions, which could, at each step, either “stop the drug”, “shift to another drug”, or go to the next step, until all five were completed.

Using this method, 58% of all drugs were discontinued (an average of 4.4 drugs per patient), with no bad outcomes from stopping the drugs.  The 70 seniors who participated averaged 82 years of age and took an average of 7.7 drugs.  Only 2% of drugs had to be restarted because of recurrence of the original symptom/problem.

Here are the five questions/steps (following the initial question above):

- Is the reason for using the medication valid and relevant in this patient’s age group and disability level?

- Do the known possible side-effects of the drug outweigh the possible benefits in old, disabled patients?

- Are there any side-effects now present that may be related to the drug?

- Is there another drug that may be superior to the one in question?

- Can the dose be reduced with no significant risk?

At the conclusion of those steps, if the drug hadn’t been stopped or changed, then the patient could continue the same dose or try reducing it anyway.

This process is something anyone can do; but, better to have your physician work with you through the steps.  Knowing your personal health goals will also help you when making decisions—for example, do you want to live as long as possible regardless of pain/suffering, or, to just live comfortably even if not as long—the quantity v. quality issue!

In general, seniors who take fewer drugs not only feel better but often live longer, something confirmed by studies of hospice patients.

Next time:  why are some people discharged from hospice?