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September 25, 2020


Reuel S. Amdur

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Deprescribing is as important for patient care as prescribing. Too many prescriptions may cause serious problems, according to Dr. Ali Elbeddini, the pharmacy manager at Winchester District Memorial Hospital. He was speaking by videoconferencing to Ottawa's Social Workers in Aging and Gerontology on September 24. Deprescribing may involve either stopping or lowering the dosage of a prescription.

According to Elbeddini, it may be time to look at possible deprescribing when a person has five or more prescriptions. He often sees people with 10 or more.  There are several causes for overprescribing.  We now have more medications than ever before, and we are living longer.  Sometimes the doctor tells the patient when to start taking a medication but may not say when to stop.  And the more one is taking, the more likely it will be that other medications are needed to treat side effects.

There are other factors.  Where conditions are complex, many medications may be prescribed.  Then, time constraints may get in the way of careful review of the patient’s drug regimen.  In some cases, there may be several doctors previously, and prescriptions may be renewed without adequate information.  Then, there is the dangerous notion that “More is better.” 

Possible adverse effects are many.  One is memory loss and confusion.  Deprescribing may offset this problem, but if not done in good time it may be too late to prevent serious deterioration. Overmedication may interfere with kidney and liver functioning.  Depending on the medications involved and the dosage, especially with older patients, there can be danger of falls, delirium, dementia, depression, dizziness, hearing loss, and insomnia.  Gait disorders may also occur. 

Elbeddini told the social workers that deprescribing is a team effort.  It may well involve hospital care to monitor the effects as medications are removed, and the decisions involve patient by-in.  When a patient has been on a specific medication, he may develop a commitment to it.  Here is where a social worker’s role may come in.

While a direct approach may work in some cases (“We’d like to get you off some of these”), not in others. The social worker or other helper may begin by asking, “How’s your sleep?”  That may provide an entrée.  Or, “I wonder about your. . . .”  The patient decides, and it is the social worker’s role to help him in making the decisions, explaining the benefits and risks and the alternatives.  For an example of an alternative, if a patient goes off drugs for insomnia, psychological treatment with cognitive behaviour therapy (CBT) might be considered. 

Elbeddini gave some data on seniors’ drug use.  Two-thirds of Canadians over 65 take five or more prescription drugs.  A quarter take 10 or more.  When it comes to risky consumption patterns, 31% of men and 42% of women in that age range are implicated. Over 85, 39% of men fall into that category.

You can get further information on the internet from the Canadian Deprescribing Network.

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