In this week’s interview, a board-certified geriatric pharmacist explains why taking an older person off a medication might be just as important as putting them on one. In fact, since prescriptions tend to accumulate over time, the delicate art of deprescribing is even more essential. This pharmacist helps physicians determine how to reduce the number of drugs a patient takes.
You may want to listen through your local public radio station or get the live stream at 7 am EDT on your computer or smart phone (wunc.org). Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on December 11, 2023.
What Is Deprescribing?A recent perspective in JAMA describes the dilemma doctors face in the title: “Deciding When It’s Better to Deprescribe Medicines Than to Continue Them” (JAMA, Nov. 29, 2023). It quotes geriatrician Eric Lee of Kaiser Permanente as saying, “We’re all taught how to prescribe these medications. We’re not taught how to stop these medications.” The result is prescription inertia, the tendency to keep prescribing a drug even if it is no longer appropriate.
What harm could that do, after all? Well, 750 older individuals are hospitalized in the US daily because of adverse drug reactions. So it is important to remember that every medicine has risks as well as benefits. As we age, the balance between those two may change. If downsides begin to outweigh the advantages, it may be time to think about deprescribing. If a pharmacist helps with that process, so much the better.
How a Pharmacist Helps Doctors with Deprescribing:Doctors who take care of older adults are the ones who may most commonly have patients who are taking half a dozen or more medicines. They may have been taking these pills for years, and it may no longer be clear that they are necessary. Some prescriptions might have been added primarily to counter side effects from previous medications.
Today’s guest urges health care providers to step back and take a look at the whole picture. How many of the problems being treated could be addressed with changes in lifestyle? Is the patient willing or even interested in making those changes? Unless someone asks the question, the patient may not even realize that could be an option.
Have You Experienced a Prescribing Cascade?Have you had the chance to tell your health care provider about a problem and received a prescription to treat it? Are you quite sure the problem being treated is a new condition–or could it be a side effect of a medication? We sometimes hear from people who eventually learn that their insomnia is a side effect of their blood pressure medicine. But the doctor prescribed a sleeping pill that caused heartburn, so they are now taking an acid suppressing drug in addition to the sleeping pill and blood pressure medicine. This is a relatively short prescribing cascade, but such chains of prescriptions to treat first one side effect and then another are all too common.
Challenges Stopping Some Medicines:One reason that not every healthcare professional embraces deprescribing is the potential for difficulties stopping a medicine. Quitting certain drugs too suddenly can trigger a discontinuation syndrome, the medical term for withdrawal symptoms. While we associate this type of trouble with opioids (and they certainly do cause it), people may also experience discomfort or even intolerable reactions when they stop other medications such as benzodiazepines, antidepressants or even certain blood pressure pills. A professional who recommends dropping a dose or phasing off a medicine altogether should be able to support a patient who has troublesome symptoms as they stop.
The Beers List as a Valuable Tool:Some decades ago, a geriatrician named Mark Beers put together a list of medicines that may be inappropriate for older patients. The list is periodically updated as a guide to healthcare providers. Here is a link to the latest version. This list is not intended to prohibit prescribing certain drugs for elderly individuals. But it should serve as a red flag for the prescriber to evaluate whether an alternative might work equally well with less risk. Such a list can be very useful when a pharmacist helps with this process.
Alert Fatigue as a Hazard for Patients:The Beers list is not the only tool a doctor or nurse practitioner might use to check on the safety of a medicine they are considering. There are interaction checkers and other warnings that are often built into the software used for prescribing. But the time pressures experienced in so many health care arenas can make these warnings less effective. If they crop up too often, physicians and pharmacists are likely to experience alert fatigue. This is a bit like the tale by Aesop in which the shepherd boy repeatedly cries wolf when there is no wolf. Consequently, when the wolf comes along to threaten his sheep, the townsfolk refuse to come to his aid, believing his plea to be groundless. Alert fatigue is a serious problem in healthcare. We are not aware of an effective remedy.
This Week’s Guest:DeLon Canterbury, PharmD, BCGP, is the founder, President and CEO of GeriatRx, Inc. He is also a Deprescribing Implementation Strategist. Dr. Canterbury is a Board Certified Geriatric Pharmacist with a passion for reducing harmful medication use in our older adults across the country.
website: www.geriatrx.org
Listen to the Podcast:The podcast of this program will be available Monday, December 11, 2023, after broadcast on Dec. 9. You can stream the show from this site and download the podcast for free.
Download the mp3.
Show 1183: How to Manage Your Foot Problems
Show 1182: How You Can Use Exercise as Medicine
Show 1180: How to Eat to Nourish Your Brain
Show 1177: How You Can Avoid Toxins in Your Home
Show 1176: The Health Benefits of Our Relationships with Animals
Show 1175: How to Mix Conventional and Ayurvedic Medicine for Cancer
Show 1174: What to Do About Skeeter Syndrome
Show 1173: How Is Diabetes Diagnosed and Treated?
Show 1145: Are Big Corporations Hacking the American Mind? (Archive)
Show 1172: How Can Antibiotics Affect Your Brain?
Show 1114: How Health Care Became Big Business (Archive)
Show 1171: How Can You Avoid the Pain of Diverticulitis?
Show 1169: What Are the Problems with Generic Drugs?
Show 1168: What Should You Know About Women’s Heart Health?
Show 1167: Will a Tick Bite Make You Allergic to Meat?
Show 1166: How Can You Manage the Misery of Seasonal Allergies?
Show 1165: Can Your Doctor’s Positive Attitude Improve Your Health?
Show 1164: Will We Win the Race Against Emerging Superbugs?
Show 1163: Should You Trust Your Prescription Drugs?
Show 1162: How to Treat Common Thyroid Problems
Create your
podcast in
minutes
It is Free
Good Mood Revolution
HyberNation: Sleep Stories and Meditations
The Fertility Conversations Podcast
Nothing much happens: bedtime stories to help you sleep
The Gary Null Show
Get Sleepy: Sleep meditation and stories