While pharmacare is a hot topic these days, there is a less-discussed aspect of prescription drugs that is gaining more and more attention from health-care professionals and patients alike — deprescribing.
Deprescribing defined
Deprescribing is defined by the Canadian Deprescribing Network as “the planned and supervised process of reducing or stopping medications that may not be beneficial or may be causing harm.” The purpose of deprescribing is to decrease the burden and harm that can result from taking multiple medications, while maintaining or improving a patient’s quality of life.
Deprescribing is part of appropriate medication use and is an essential element of good prescribing. According to the Canadian Deprescribing Network, appropriate medication use means that patients receive the correct dose of the correct medications through the best delivery system, at the right time and for the correct length of time. As such, deprescribing should be considered when a medication is initially prescribed as well as throughout the period that an individual is taking a prescription and must always be done in consultation with a healthcare professional.
Why deprescribing matters
In its report, Drug Use Among Seniors in Canada, 2016, the Canadian Institute for Health Information (CIHI) found that nearly two-thirds of older adults are taking five or more prescription drugs, while more than one quarter of older adults are taking 10 or more prescription drugs. While these medications provide many benefits for people suffering from chronic conditions, the side effects and drug interactions that can result from using multiple medications pose a risk. Taking five or more different drugs, also referred to as polypharmacy, increases the risk of adverse drug reactions, cognitive impairment, memory problems, impaired balance, falls and hospitalization. Deprescribing can play an important role in helping reduce the risks associated with taking multiple medications, improving overall health and easing the burden on our health-care system.
As we age or become more ill, the use of certain medications may become less useful or even harmful. Further complicating this issue is the fact that older adults and those with chronic conditions are often not included in drug testing, meaning there is limited information available regarding how prescription drugs affect older adults and how they interact with other prescription drugs an individual may be taking. The result is that optimizing the use of medications becomes an essential part of managing chronic conditions.
Deprescribing also highlights that there could be non-medication, evidence-based options to treating certain symptoms or conditions. Incorporating deprescribing into the prescribing process can encourage healthcare providers, patients and their caregivers to discuss solutions other than medication that can help alleviate or treat a condition. As awareness about deprescribing becomes more widespread, it may help shift views that prescribing medication should be the default approach to treatment and create a willingness to try non-medication, evidence based options when available.
Steps you can take
The previous sections emphasize the importance of engaging with your health-care providers about deprescribing while assessing the medications you are taking to ensure they reflect any changes in your health status, body or life circumstances. With that in mind, there are things you can do to learn more about deprescribing and apply its principles to the health care you receive.
Get informed
Several organizations and initiatives across the country are dedicated to raising awareness about deprescribing and appropriate medication use. Many have developed resources to educate patients and their caregivers on these concepts as well as tools to help you assess whether your medications are still appropriate for you. Many also have resources for healthcare professionals that you can share to start the conversation about deprescribing. Visit www.federalretirees.ca/sage-deprescribing to view our web post on deprescribing organizations and resources.
It is also important to inform yourself about the medications you are taking and why. You should be familiar with what each medication you take is treating, its side effects, the dosage, how it should be taken and for how long. This applies to all medications you take, not just prescriptions.
Book an appointment to review your medications or those of an older adult in your life
Since there is often a lot to get to in regularly scheduled appointments with your healthcare providers, booking an appointment specifically to review your medications is the best way to ensure you can have a meaningful discussion about deprescribing and whether the medications you are taking remain appropriate for you. You should prepare for the appointment by gathering any information or resources you want to share with your health-care provider and writing down questions you want to ask about your prescriptions. SaferMedsNL and Choosing Wisely Newfoundland and Labrador, two organizations focused on promoting the appropriate use of medication, suggest asking your health-care provider the following questions:
- Do I really need this medication?
- How can we work together to reduce my dose?
- Is there a simpler, safer option?
- What symptoms should I look for when I stop my medication?
- With whom do I follow up and when?
Remember, the appropriateness of medications can change over time as a result of changes to your health status, body or life circumstances. You should periodically schedule appointments to review your medications with your health-care providers.
Help spread awareness about deprescribing
Now that you are familiar with the concept, you can help spread awareness about deprescribing to others. You can share the information you have learned and resources you have come across with other older adults in your life as well as with the organizations and community groups to which you belong.
Some of our members are already spreading the word about deprescribing within their communities. Dorma Grant, advocacy program officer for Federal Retirees in New Brunswick, has attended several conferences on this topic. She is using the information she gained at these conferences to spread awareness and share resources about deprescribing with branches in New Brunswick, encouraging them to organize events to inform members about deprescribing. Shirley Pierce, advocacy program officer on Prince Edward Island, has also attended various forums on deprescribing. She is using the information she gained on this subject to raise awareness about deprescribing with the organizations to which she belongs, including organizing information sessions and speaker events, writing articles and advocating for the importance of deprescribing with community and provincial bodies, such as Prince Edward Island’s Seniors Secretariat.
Disclaimer: This article provides general information about health and related subjects. The information and resources mentioned in this article are not intended and should not be construed as medical advice, nor is the information a substitute for professional medical expertise or treatment. Before making any changes to the medications you take or how you take them, consult your health-care provider.