De-prescribing the elderly

Western Australian medical researchers say elderly patients are frequently prescribed too many medications and could have a better quality of life if they stopped taking some of them.

University of Western Australia’s Centre for Health and Ageing (WACHA) is planning a double-blind study in regional WA to assess the effects of de-prescribing drugs issued to patients in residential aged care facilities with the aim of getting them off as many medications as possible.

Participants will be independently assessed by two researchers who, in consultation with the patient’s regular doctor, will build a list of medications to be withdrawn in sequence, starting with those causing problems or that need to be withdrawn gradually and ending with those most likely to cause an adverse withdrawal event.

WACHA research fellow assistant, Professor Kathleen Potter, tells DPS News they will be tailoring the 12 month study for individual patients.

“We’re trying to withdraw anything we don’t think is benefiting the patient,” she says.

“It may have been started when they had symptoms they no longer have or was appropriate at one point in their lives but isn’t anymore.”

Researchers will target medications that are redundant, reduce quality of life or are causing side effects, particularly when they are interacting with other medications.

“All medicines have risks and benefits so it’s a matter of weighing up for the individual if the benefits outweigh the risk,” Prof Potter says.

“Sometimes that equation changes as people age because the way they metabolise drugs changes so they can be more at risk of experiencing adverse effects and there may be less benefit from the drug overall.

“Drug companies have a strong interest in encouraging doctors to prescribe medicines.”

Patients will be monitored by nursing home staff for signs of adverse effects and reviewed twice weekly by WACHA researchers for two weeks following the withdrawal or dose reduction of each drug and if there are no adverse effects they will progress to the next one.

The study’s secondary outcome is to improve participant’s quality of life in their memory, concentration sleep quality and level of independence three, six and 12 months after the removal of drugs.

The study has a target of 200 participants from the mid west region and may be extended to Bunbury and Busselton.