Deprescribing for Older Adults Flashcards
Barriers to deprescribing
Sociocultural: Medical culture of prescribing
Relational: Uncertainty, fear/accountability, professional relationships
Organizational: Limited time, no targeted funding, care fragmentation
Individual: Patient uncertainty, “Doctor knows best”, impaired cognition
Facilitators of Deprescribing
Sociocultural: Acknowledging the complexity of multi-morbidity and frailty, less is sometimes more
Relational: Continuity of care, mechanisms for communication between providers
Organizational: Reimbursement for deprescribing, access to support resources
Individual: Awareness of potential harms of continuation, discuss goals of care
Process of deprescribing
Comprehensive medication history
Identify potentially inappropriate medication
Determine eligibility for deprescribing and prioritize
Plan and initiate withdrawal
Monitor, support, and document
Potential drug-induced harm: drug factors
Number of medications prescribed
Use of potentially inappropriate or “high risk” medications
Past or current toxicity
Potential Drug-Induced Harm: Patient Factors
Age > 80 years old
Cognitive impairment
Multiple comorbidities
Multiple prescribers
Prioritization of discontinuation
- Those with the likelihood of greatest harm and least benefit
- Those easiest to discontinue
- Those that the patient is most willing to discontinue first
TTB
The time it takes for a medications effect to become evident in a population
TTH
The time until a significantly significant adverse effect is seen in a trial for the treatment group compared to the control group
TTB for bisphosphonates
8-19 months
TTB for statins
2-5 years
TTB for hypertension
1-2 years
TTB for aspirin
10 years
TTB for intensive glycemic control in diabetes
10 years
