Through the years, I have seen many clients who transitioned to hospice show considerable improvement in their condition. The primary reason for this is probably secondary to the cessation of all meds not related to comfort. Polypharmacy has become an epidemic in our older adult population. The World Health Organization recognizes medication-related harm as a global health issue. When two drugs are used in combination, the potential for interaction is about 6%. When someone is on five drugs, the risk of interactions increases to 50% and by the time someone is taking more than eight medications, the risk of drug to drug interactions rises to almost 100%. Some of these interactions can result in morbidity and mortality often masquerading as falls or delirium and are thus misclassified and unrecognized. Furthermore, older adults undergo physiologic changes in absorption, distribution, metabolism, and excretion of medications that compound their risk of harm.
We live in a quick-fix society and often expect a new prescription every time we visit our primary care provider with a new health concern. Many times it is easier (and faster) to offer a prescription than to try to explain to someone why they do not need that purple pill that was advertised on T.V. In addition, our medical professional organizations are great at telling us when to add a new agent based on our client’s condition but offer few suggestions on how and when to de-prescribe.
We have professional bodies, like AMDA and the BEERS list, who have offered sound counsel on medication management for older adults. Unfortunately, the data supports that most older adults remain on medications shown to increase their risk of harm including falls. Please book a presentation on De-prescribing or The BEERS list to learn more about medication management for older adults. Together, we can advocate for safe prescribing practices for our seniors.