New guidelines may help reduce medication use among seniors

We're not getting any younger. According to the Administration for Community Living, by 2060, there will be about 98 million older persons in the United States — more than twice their number in 2013.

Advancing age leads to more medical problems. It's not uncommon to see seniors suffering from a host of ailments — and using a range of drugs to deal with them. Seniors 65 years and older represent 13 percent of the population, but are responsible for over than one-third of total outpatient spending on prescription drugs in the United States.

While this "polypharmacy" approach might help cure some problems, it can often lead to others, such as an increased risk of falls, hospitalization, institutionalization and mortality.

A group of researchers — led by James Conklin, an associate professor in Concordia University's Department of Applied Human Sciences, and by Barbara Farrell of the Bruyère Research Institute and Department of Family Medicine, University of Ottawa — is working to reverse the trend through a new project, "Deprescribing Guidelines for the Elderly."

Funded by the Government of Ontario through OPEN — Ontario Pharmacy Research Collaboration — the project aims to develop and evaluate guidelines to support health-care professionals in tapering or stopping medications in elderly patients, while monitoring for withdrawal reactions.

"Polypharmacy among the elderly is such a difficult problem in Canada, with significant impacts upon both quality of life and health-system costs. As life changes, medications that were once right for a person may no longer be the best choice for them," says Conklin.

For the project, Conklin and his colleagues examined three commonly used classes of drugs:

1. Proton pump inhibitors — they reduce acid production in the stomach, commonly used to treat heartburn.
2. Benzodiazepine receptor agonists — they cause sedation, commonly used for insomnia.
3. Antipsychotics — they cause sedation, commonly used for behavioural symptoms of dementia and sometimes for insomnia.

For each drug class, the team developed evidence-based guidelines along with decision-aid algorithms, which provide advice for primary care clinicians, and those who practice at long-term care facilities.

They use the algorithms to help reduce medications that may be causing problems or are no longer needed for their patients.

The researchers have implemented the algorithms in three Family Health Teams and three long-term care homes in eastern Ontario.

"My hope is that the guidelines and algorithms we develop will help improve the medication-related health of seniors," says Conklin.

"Fewer medications taken mean fewer adverse drug reactions. At the same time, I hope that having set guidelines will help improve the confidence of clinicians in tapering or stopping medications, while supporting a cultural shift in health care toward reassessing medication use as people age."