Taken from Chapter 8, “Deprescribing” from the book, “Live Young, Two Times Longer”.
It is well known that statistically, the older people get, the more medication they take. To give an order of magnitude, after 65 years of age, the majority of patients (two out of three Canadians) consume five or more different medications per day, and 40% of patients aged 85 and over consume 10 or more per day. It is estimated that between 30 and 40% of patients over the age of 65 consume at least one unnecessary or inappropriate medication.
The Association des pharmaciens des établissements de santé du Québec (APES) conducted an analysis with 4317 residents in 34 CHSLDs in six regions of the province. Conclusion: each resident of these centers has an average of 14 different prescriptions for drugs. Is it normal to consume so many medications, when these same patients are at a time in their life when they undergo many physiological and pharmacokinetic changes, which increase the risks associated with the use of medications?
This is the subject that we will discuss in this article. In 2024, 20.1% of the Canadian population will be over 65 years of age. Aging, without being a pathology in itself, leads to a deficiency of several systems which, cumulatively, increases the fragility and vulnerability of the individual. Has the medical world really adapted its way of prescribing accordingly? The situation is worrying to say the least and some form of action is required.
It is important to mention that deprescription exists and it is even a standard practice in some CHSLDs.
It could be better used if patients (and certain health professionals too…) were better informed of the drawbacks related to taking medication, and above all, made aware of the fact that physiological changes occurring over time are likely to change the effects of medications on their health.
The effects of aging
It is understood that aging generates a lot of changes within the individual: weight changes, decrease in neurotransmitters, hormonal changes, change in sleep structure, weakening of the immune system, more or less chronic fatigue, decrease in endurance, loss visual acuity, withdrawal from social life, not to mention cognitive problems and difficulty concentrating.
An aging person will be weakened. It therefore becomes obvious that the effect of the medicines will be impaired. Based on the factors listed above, one can easily think of changes about drug absorption (which in general will be delayed or decreased), distribution (changed), metabolism (decreased) and elimination (decreased).
The World Health Organization (WHO) has even described a “geriatric syndrome”, including in particular:
- Urinary incontinence ;
- Sensory deficits;
- Weight loss and anorexia;
- Fatigue or weakness;
- Confusion ;
It therefore makes sense to conclude that the use of a previously effective and appropriate medication may need to be reassessed as the patient ages, possibly with a lower dose, or even stopped completely for some. It may happen that with the appearance of new health issues or the simply the natural aging process, what was previously a perfectly justified medication, can now cause more harm than good.
It is crucial for healthcare professionals to seek to optimize the use of medication, and aim that deprescription be much a part of the process as a prescription. In the next two articles, we will talk about prescribing cascades, how to avoid them, and deprescribing from the doctors’ point of view, Dr Jacques Lambert. In the meantime, don’t hesitate to ask your pharmacist or doctor questions about the reasons and functions of your medications.