Reducing the number of medications older adults use can have surprising benefits, according to research presented in a new issue of the journal Public Policy & Aging Report from The Gerontological Society of America.
Titled "Comorbidity, Deprescribing, and the Healthcare of Older People" and supported by Age UK, the issue explores the role of deprescribing -- defined as the "the systematic process of identifying and discontinuing drugs in instances in which existing or potential harms outweigh existing or potential benefits within the context of an individual patient's care goals, current level of functioning, life expectancy, values, and preferences" -- as a solution to polypharmacy.
James Goodwin, PhD, then the chief scientist at Age UK, served as guest editor. He joined with Public Policy & Aging Report Editor in Chief Brian Kaskie, PhD, of the University of Iowa to write an introduction for the issue's ten articles. They summarized the authors' identification of several factors that contribute to polypharmacy in older adults:
- An increasing complexity of health care delivery, irrespective of the national setting, leading to problems of coordination between caregivers, physicians, and patients;
- The rise of co-morbidities and chronic long-term illnesses as the population ages;
- The huge numbers of available pharmaceuticals and their widespread use;
- The construction of guidelines based on single diseases, randomized control trials of low external validity, and drugs untested in the older population;
- Marginalization and disempowerment of older patients, with the absence of shared decision-making; and
- A culture in Western societies that is expectant of medical intervention at all levels.
Collectively, the articles in the new Public Policy & Aging Report addresses ethical and policy issues related to deprescribing and explore the application of this approach in practice, including how to address barriers to deprescribing.
"And as this edition shows, we know more than ever about the current state of polypharmacy, a modern epidemic which has the potential to blight the lives of millions of older people. Yet progress is slow," Goodwin and Kaskie state. "Let us hope that by extending our understanding and the possibilities for improvement, we reduce the risks and increase the health and quality of life of our aging populations."